Fresh questions are being raised about the long-term use of antidepressants, with Australian researchers arguing that current evidence may overstate their benefits beyond the first year of treatment and that patients should have their medication reviewed more regularly.
A clinical overview published in the Australian Journal of General Practice has brought together existing research on antidepressant use, highlighting what the authors describe as limited evidence supporting long-term treatment and growing concerns about potential health risks.
Researchers from Adelaide University and The University of Queensland contributed to the review, which recommends treatment reviews every six months and greater consideration of alternative approaches to managing depression and anxiety.
Associate Professor Mark Horowitz, a psychiatrist at Adelaide University’s School of Medicine, said much of the evidence supporting long-term antidepressant use comes from studies known as relapse prevention trials.
According to Dr Horowitz, these studies often compare people who continue taking antidepressants with those who stop treatment abruptly or over a short period. He argues that the design of these studies may make it difficult to distinguish between withdrawal symptoms and the return of depression.
“These studies typically compare patients who continue medication with those who stop abruptly or rapidly. Because they don’t distinguish between withdrawal symptoms and the return of depression, we believe many apparent relapses may actually be withdrawal effects from the medication,” he said.
The review notes that short-term clinical trials generally show modest differences between antidepressants and placebo treatments. It also points to research suggesting that some benefits observed in long-term studies could be linked to the suppression of withdrawal symptoms rather than prevention of future depressive episodes.
The authors highlight a range of risks associated with extended antidepressant use, including sexual dysfunction, emotional blunting, cognitive difficulties, weight gain and increased physical health risks among older adults.
Withdrawal symptoms can also be challenging for some patients. Researchers note that symptoms such as anxiety, insomnia and low mood may occur both during antidepressant withdrawal and during a relapse of depression, making it difficult to separate the two without careful assessment.
The review arrives as antidepressant use remains widespread in Australia. Nearly one in seven Australians are taking antidepressants, and around one-third of users continue treatment for more than a year.
Professor Katharine Wallis, Head of General Practice at The University of Queensland Medical School, said there is increasing awareness among healthcare professionals about the need to regularly assess whether ongoing treatment remains appropriate.
“As GPs, we are becoming more aware of the limited benefits and possible harms associated with long-term antidepressant use and the need to reconsider the ‘set and forget’ approach to prescribing these medicines,” Professor Wallis said.
She said there is growing emphasis on helping patients make informed decisions about their treatment and supporting those who wish to stop antidepressants through gradual dose reduction.
The authors also encourage broader use of psychological therapies and other non-drug treatments, arguing that many people recover from depression without remaining on medication indefinitely.
At the same time, mental health experts generally stress that antidepressants remain an important treatment option for many people, particularly those experiencing moderate to severe depression. Decisions about starting, continuing or stopping medication are typically made on an individual basis between patients and their healthcare providers.
The researchers say their findings are intended to encourage a reassessment of long-term prescribing practices and ensure patients receive regular reviews of treatment benefits, risks and alternatives.
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