An antidepressant is now one of Australia’s most commonly prescribed drugs – but why?

An antidepressant has become one of Australia’s most commonly prescribed drugs for the first time.
 
Sertraline – sold as Zoloft – has entered Australian Prescriber’s top 10 most commonly taken medications on a standard daily-dose basis for the first time.
 
The drug is at 25.67 defined daily doses per day, narrowly ahead of common diabetes drug metformin, on 25.51.
 
More than 4.7 million prescriptions for the antidepressant were issued between July 2019 and June 2020.
 
But an expert has called for caution in interpreting the trend, given the reasons for the increase are currently unknown.
 
The measure time period overlaps with the start of the COVID-19 pandemic, which saw a sharp rise in mental health issues, according to a large survey recently published in the Medical Journal of Australia.
 
newsGP reported anti-anxiety drug prescription rates rose by between 13% and 22% over the eight weeks to the end of June.
 
However, The Guardian reports women in particular are being prescribed sertraline more, likely to due to depression linked to cumulative life traumas, according to the director of the Monash Alfred Psychiatry Research Centre Professor Jayashri Kulkarni.
 
Dr Michael Tam, GP and member of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP it is important to be careful about the narratives and explanations given for this kind of data.
 
‘Sertraline is one of the first-line SSRI [selective serotonin reuptake inhibitors] antidepressants used for major depressive disorder and anxiety disorders as well,’ he said. ‘It may be an indication some of these high-prevalence mental disorders have become more common, but we don’t know if this is the case.
 
‘Each agent needs to be thought of individually. If there’s a question of whether it’s being used too often or not often enough, you can’t make that judgement simply by being on this list. It’s often complex.
 
‘Take antidepressants – they’re overused in people who are not likely to benefit, but at the same time they tend to be underused in people with severe depression who may well benefit. It’s not uncommon for people to not be on a high enough dose or not for long enough.
 
‘So our narrative needs to be quite careful.’
 
Having said that, explanations can be simpler – such as the fact that eight of the top ten drugs treat cardiovascular disease in some way.
 
‘Cardiovascular disease [CVD] drugs are an indication that CVD is a very high prevalence chronic disease,’ Dr Tam said. ‘A lot of people have it, and can live with it for a long period of time.’  
 
The Australian Prescriber data also captures the most expensive medication on the Pharmaceutical Benefits Scheme (PBS), which in 2019–20 is aflibercept, costing the Government close to $400 million for over 300,000 prescriptions. The drug can treat wet macular degeneration as well as metastatic colorectal cancer.
 
In 2018–19 and 2017–18, the medication costing the Government most – over $1 billion in those two years – was the combination of sofosbuvir and velpatasvir, used to treat Hepatitis C.
 
‘With hepatitis C, it’s understandable why it’s gone up. It’s quite expensive, but you could argue this is quite a good thing, given it is now “curable”,’ Dr Tam said. 
 
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