Push for more reviews of antidepressant use

Long-term antidepressant use is on the rise but evidence for its role in preventing relapse is likely to be exaggerated, a clinical overview in the latest Australian Journal of General Practice (AJGP) has found.
 
Under a theme of ‘When less is more’, researchers from Adelaide University and the University of Queensland (UQ) probed both the benefits and harms of continuing antidepressant use.  
 
‘The evidence justifying long-term use of antidepressants is likely to exaggerate the relapse prevention properties of antidepressants by mis-classifying withdrawal effects as relapse,’ the authors wrote.
 
‘Given a lack of reliable evidence for benefit and established evidence of harm, antidepressants should be regularly reviewed with shared decision-making about whether to continue or stop.’
 
With almost four million Australians taking antidepressants in 2024–25, co-author Professor Katharine Wallis, Head of the General Practice Clinical Unit at UQ, says evidence has changed substantially since GPs first started prescribing the medications.
 
‘Long-term use of antidepressants, that is longer than 12 months, is not recommended for most people, and yet long-term use is very common in Australia and internationally,’ she told newsGP.  
 
‘And that’s because people struggle to stop taking the antidepressants because of antidepressant withdrawal symptoms, [which] we didn’t know much about when antidepressants first came out … and we first started prescribing them.
 
‘Patients have been under the misapprehension that the antidepressants are working by correcting a chemical imbalance in their brain, but we now know that’s absolutely not true, there’s absolutely no evidence of that.’
 
The article reports that GPs prescribe 92% of antidepressants in Australia, with Professor Wallis hoping a shift in approach will lead to a decline in long-term use.
 
‘GPs do the bulk of the heavy lifting in the mental health space – by far and away, this is a general practice issue,’ she said. 
 
‘It’s going to require a turnaround to understand that it’s not relapse people experience, it’s actually withdrawal symptoms.
 
‘GPs are seeing people who are taking antidepressants every day – and it requires a bit of a shift to initiate that discussion with patients, “have they ever thought about stopping?”’
 
While withdrawal symptoms are common, and sometimes severe, Professor Wallis points to a range of RACGP-approved resources GPs can use, including the RELEASE toolkit through the University of Queensland, and other tapering schedules, to support deprescribing.
 
‘There’s an argument, “why rock the boat?”,’ she said.

‘But it is possible to minimise withdrawal symptoms by gradually reducing the dose over many weeks or months.’
 
The article also highlights growing evidence of adverse effects linked to long-term use, including sexual dysfunction, emotional numbing, cognitive impairment, weight gain and greater physical health risks in older adults.
 
Co-author Mark Horowitz, an Associate Professor of Psychiatry at Adelaide University’s School of Medicine, said that symptoms for anxiety, low mood and insomnia can present both during withdrawal from antidepressants and the return of depression.
 
‘As these studies do not distinguish between them, they will mis-categorise withdrawal as a return of depression as this is the focus of such studies,’ he said.

‘If the same approach was taken with cigarettes and feeling worse on stopping them was interpreted as evidence that people should continue smoking them, we know that would be absurd. But the same sort of evidence is used to recommend long-term antidepressants.

‘Guidelines need to be updated to reflect that there are no good studies which show that antidepressants are effective in the long term.’

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AJGP antidepressant Australian Journal of General Practice