Changes in antidepressant use in Australia: A nationwide analysis (2015–2021)

  1. Juliana de Oliveira Costa
  2. Malcolm B. Gillies
  3. Andrea L. Schaffer
  4. David Peiris
  5. Helga Zoega
  6. Sallie-Anne Pearson

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Abstract

Depression and anxiety affect 4–14% of Australians every year; symptoms may have been exacerbated during the COVID-19 pandemic. We examined recent patterns of antidepressant use in Australia in the period 2015–2021, which includes the first year of the pandemic.

Methods:

We used national dispensing claims for people aged ⩾10 years to investigate annual trends in prevalent and new antidepressant use (no antidepressants dispensed in the year prior). We conducted stratified analyses by sex, age group and antidepressant class. We report outcomes from 2015 to 2019 and used time series analysis to quantify changes during the first year of the COVID-19 pandemic (March 2020–February 2021).

Results:

In 2019, the annual prevalence of antidepressant use was 170.4 per 1000 women and 101.8 per 1000 men, an increase of 7.0% and 9.2% from 2015, respectively. New antidepressant use also increased for both sexes (3.0% for women and 4.9% for men) and across most age groups, particularly among adolescents (aged 10–17 years; 46–57%). During the first year of the COVID-19 pandemic, we observed higher than expected prevalent use (+2.2%, 95% CI = [0.3%, 4.2%]) among females, corresponding to a predicted excess of 45,217 (95% CI = [5,819, 84,614]) females dispensed antidepressants. The largest increases during the first year of the pandemic occurred among female adolescents for both prevalent (+11.7%, 95% CI = [4.1%, 20.5%]) and new antidepressant use (+15.6%, 95% CI = [8.5%, 23.7%]).

Conclusion:

Antidepressant use continues to increase in Australia overall and especially among young people. We found a differential impact of the COVID-19 pandemic in treated depression and anxiety, greater among females than males, and greater among young females than other age groups, suggesting an increased mental health burden in populations already on a trajectory of increased use of antidepressants prior to the pandemic. Reasons for these differences require further investigation.

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  1. Version published to 10.1177/00048674221079740
  2. ScreenIT

    SciScore for 10.1101/2021.11.24.21266837: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: Our study is a contemporary, national perspective on patterns of antidepressant use by age and sex, generating insights for mental health services planning. Our analysis of the first year of COVID-19 in Australia identifies the population subgroups most affected by the pandemic, looking beyond the initial stockpiling effects in the early months of the pandemic and considering the impact of population estimate uncertainty on rates of antidepressant use. The main limitations of this study are related to the scope of PBS data. The lack of information on reasons for prescription means antidepressants could have been prescribed for conditions other than anxiety and depression. This is particularly relevant for SNRIs and TCAs, commonly used to treat pain. In addition, since PBS data do not include private and inpatient prescriptions in public hospitals, we underestimate the population-level use of antidepressants. Additionally, due to the drug utilisation design of the study, we provide limited insight into the course of treatment at an individual rather than population level. Finally, our findings are likely only generalisable to other jurisdictions where the circulation of SARS-CoV-2 was limited. We also expect differences in later Australian data due to the higher case numbers and extended lockdown in 2021.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.11.24.21266837v1 on medRxiv