Full Breakdown
Reassessing Long-Term Antidepressant Use in Australia
6/3/2026, 7:56:51 PM
Core Findings: Limited Evidence for Long-Term Benefit
A clinical overview in the Australian Journal of General Practice finds little robust evidence that antidepressants prevent relapse beyond 12 months. The authors argue that relapse-prevention trials compare continuous medication with abrupt cessation, conflating withdrawal symptoms with true depressive recurrence, thereby overstating long-term efficacy.
Prescription Landscape in Australia
Approximately four million Australians (one in seven) use antidepressants; a third remain on them for over a year and a quarter for more than two years, representing about one million long-term users. General practitioners prescribe 92 % of these drugs, often in cases that do not meet guideline criteria.
Key Voices and Institutional Context
Associate Professor Mark Horowitz (University of Adelaide) led the review; Professor Katharine Wallis (University of Queensland) co-authored the commentary. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has removed the “chemical imbalance” model from its website, and the Royal Australian College of General Practitioners (RACGP) endorses the Maudsley Deprescribing Guidelines and the RELEASE toolkit for tapering.
Official Statements & Responses
The review links prolonged use to sexual dysfunction, emotional numbing, weight gain, cognitive impairment and heightened withdrawal risk. Withdrawal symptoms affect up to 15 % of long-term users, with severe, protracted cases in about 10 % and increasing with duration. Authors recommend six-month medication reviews, shared decision-making, gradual dose reduction, and guideline revisions that acknowledge the lack of long-term efficacy data.
Patient Preferences and Criticisms
Some patients choose to stay on antidepressants despite not meeting clinical criteria, citing life stressors or perceived emotional stability. Clinicians note that abrupt cessation can be distressing and stress the need for individualized tapering plans while balancing patient autonomy with documented harms.
Verbatim Quotes
- “Much of the evidence supporting long-term antidepressant treatment comes from so-called relapse prevention trials,” — Mark Horowitz, Associate Professor of Psychiatry, University of Adelaide
- “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.” — Mark Horowitz
- “Concerningly, the risk of withdrawal effects appears to increase with the duration of use – one reason for stopping antidepressants sooner rather than later,” — Mark Horowitz
- “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,” — Katharine Wallis, Professor of General Practice, University of Queensland
Next Steps
The authors recommend that health authorities embed six-month review cycles in clinical pathways, expand training on hyperbolic tapering, and promote non-pharmacological therapies such as evidence-based psychotherapies and lifestyle interventions. Ongoing research aims to clarify the risk-benefit profile of prolonged antidepressant use.
