Anti-depressant prescribing

| January 24, 2014

Australian doctors are among the highest prescribers of anti-depressants worldwide. AMA President Dr Steve Hambleton thinks that while it’s a good thing that more people seek help for depression, the health system should better support doctors to spend more time with their patients.

The OECD report, Health at a Glance 2013, comparing the health and health care of member countries, reported that Australian medical practitioners are the second highest prescribers of anti-depressants.

We don’t know whether this is an appropriate level of prescribing or not without further research. It is easy to jump to the conclusion that Australian doctors must be overprescribing.

But there could be other, more complex explanations, such as the steady de-stigmatisation of depression in Australia over the last few years.

This is likely to be encouraging more people to seek help from their doctor for anxiety and depression. And this is a good thing.

Mental illness is also increasing overall in most developed countries and this may be having an impact on Australia’s prescribing statistics where a range of anti-depressants are subsidised and therefore affordable under the Pharmaceutical Benefits Scheme.

Other possible contributions to high prescribing rates may be patients pushing their doctors for a prescription or even the health system design, which fails to support longer consultations compared with shorter ones.

All doctors have had the experience of patients who are not satisfied unless their consultation ends with a prescription.

The attitude that taking a pill is a quick and easy fix needs to change. Of course, in some cases a prescription of anti-depressants is completely appropriate.

But it’s important that, in many cases, other options such as one-to-one counselling are considered and tried first. In some cases, lifestyle changes, such as improving diet and exercising and work life balance, can be effective on their own.

These take more effort from the patient and also require the doctor to spend more time talking to the patient about their situation. However, our current Medicare rebate system doesn’t encourage or support doctors, particularly our GPs, to do this.

The Medicare rebate for general practitioner consultations has not kept up with the rising costs of providing health care. The rebate for a long consultation is only 50 per cent of the AMA’s recommended fee, which is based on practitioner costs today.

To compound the problem, last year the Government froze any increases in the Medicare rebate until July 2014.

A couple of years ago, the Government also slashed Medicare rebates for general practice mental health services and mental health care plans. This has led to fewer GP mental health services being provided and to some patients facing higher out of pocket costs.

In summary, the high rate of anti-depressant prescribing in Australia is not necessarily a bad thing, but the health system should also better support doctors to spend time with their patients – applying ‘talking therapy’.

Patients who are prescribed anti-depressants should make sure they discuss with their doctor how to use them safely and effectively, and that they understand any potential side effects or interactions with other medicines. Before they stop taking them they should also consult with their treating doctor, as many of the drugs need gradual withdrawal.



  1. Al


    February 17, 2014 at 5:23 am

    drugs for depression cases

    Dr Hambleton's comments re lifestyle, diet, etc make more sense to me than drugs. Having been through some depression following a stroke, I was and still am determined to beat this without drugs. My current research into the 'neuroplasticity' of the brain is leading me more and more towards brain training as a long term and healthier in all ways option. Barbara Arrowsmith-Young has been developing the Arrowsmith school program in Toronto for some three decades, now expanding into Australia as well. This school has developed specific brain training exercises for the specific areas of the brain that control various cognitive and other functions. By working on a program designed specifically for the student over a long period, from months onwards, Barbara has seen many vast improvements in the areas targeted and other areas related to them. Interestingly, other research in brain training has seen improvements in areas such as depression, ADHD and even weight loss. It seems to me to be an area demanding much more Australian research and speedy implementation in the name of quality of life for the many, and less drugs in our systems.

  2. Cam


    March 4, 2014 at 6:26 am

    Anti-depressant prescribing

    If the underlying problem is genetic then one can be supportive of the use of an RSI or similar prescribed medication. "The attitude that taking a pill is a quick and easy fix needs to change" if the cause of the depression is environmental. I was amazed when a visiting nurse from Bulawayo, Zimbabwe made the comment that this Western lifestyle was easy to get used to and then was asked by a GP at the function we were attending, what the biggest medical problem was in Australia today. The nurse had no idea and when told that it was depression, the nurse questioned what Australians had to be depressed about. A holistic approach to the root causes and a united effort by health practitioners and those involved with mental health here in Australia would be a start in reducing the dependency on anti-depressant drugs. I look forward to seeing effective solutions implemented by health professionals and our civil society becoming naturally happy and content without the use of medication.