Average duration of treatment with antidepressants among concession card holders in Australia

Abstract

While recommendations have underlined the importance of giving antidepressants for a sufficient period of time, the results from this study show that it is as important to remind general practitioners to review patients on antidepressant treatment regularly, and try to cease drug treatment when timely.

Psychotropic medication use in Australia, 2007 to 2015: Changes in annual incidence, prevalence and treatment exposure

“…For antidepressants, treatment guidelines suggest 6-12 months of treatment for persons experiencing a single episode of depression, but long-term treatment (3-5 years) for recurrent episodes (Therapeutic Guidelines Limited, 2013). However, recent international studies indicate trends toward longer durations of treatment (average of 4-5 years) and suggest that some of this may represent overuse (Johnson et al, 2012;Kjosavik et al, 2015). Increases in the median annual dose used for antidepressants over the study period also warrant further investigation as there are concerns from within the medical community about antidepressant dose escalations for those who have failed to respond to standard doses despite a lack of supporting evidence (Jureidini and Tonkin, 2006).…”

“…Increases in antidepressant and antipsychotic use appear to underlie these changes worldwide, although increases in the use of psychostimulants have also been reported (Ilyas and Moncrieff, 2012;Olfson et al, 2014;Renoux et al, 2016;Stephenson et al, 2013). While some of this growth undoubtedly represents better access to treatment and improved quality of care in mental illness, there are concerns about over-treatment of some patient groups and increasing off-label use (Kjosavik et al, 2015;McKean and Monasterio, 2012).…”

The extent of antipsychotic use in Australian residential aged care facilities and interventions shown to be effective in reducing antipsychotic use: A literature review

“…However, BPSD is often inappropriately managed with antipsychotics before implementing non-pharmacological strategies, and this has been associated with harm among older people (Banerjee, 2009; Macfarlane & O'Connor, 2016). An Australian study that examined antipsychotics dispensed to concession card holders between 2010 and 2013 found the incidence of antipsychotic use was highest in people aged 75 years and older, with an average duration of use of 1.5 years (Kjosavik, Gillam, & Roughead, 2017). People with dementia living in RACFs who are prescribed an antipsychotic are almost 2.5 times as likely to be hospitalised for an adverse event or to die within 90 days of starting treatment (Macfarlane & O'Connor, 2016).…”

Antidepressant prescribing in general practice: A call to action

“…3 Evidence suggests long-term use (>12 months), rather than new diagnoses, is driving the increase. [4][5][6] GPs prescribe most antidepressants in Australia (86.3%). 7 Often, antidepressant prescribing is not consistent with clinical guidance.…”

“…7 Clinical guidelines recommend psychological therapies for mild depression and anxiety, and 6-12 months of antidepressant therapy for a single episode of moderateto-severe depression. 8,9 Yet in Australia the average duration of therapy is now approximately four years, 4 and half of users are long-term users. 5 There is also concerning variation in antidepressant prescribing, with rates higher for people in lower socioeconomic or inner regional areas and nearly double in older (≥65 years) when compared with younger people.…”