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Psychiatric Drugs in Australia – Who is taking What?
Australians are among the world’s highest users of psychiatric drugs. From July 2200 to June 2021, more than one in six Australians (4.5million+ patients being 17.7% of the population) were dispensed at least one mental health-related medication.
Antidepressants were easily the most commonly dispensed (3,503,862 patients), with the next most common being Anxiolytics (904,253), Hypnotics and Sedatives (618,952), Antipsychotics (493,850), and Stimulants (288,098).[1] Hundreds of thousands of patients were dispensed more than one type of psychiatric medication, however the actual number is unclear.
Despite the fact that they have limited psychiatric and neurological training the vast majority (84.7%) of prescriptions were made by general practitioners. Psychiatrists only prescribed 7.5% of the total number of scripts.
Older Australians were the heaviest users, with a staggering 41% of those aged over 84 years dispensed at least one psychiatric medication. Rates rose progressively through the older age groups (0-4 years 0.2%, 5-11 years 4.8%, 12-17 years 9.5%, 18-24 years 14.1%, 25-34 years 14.9%, 35-44 years 18.5%, 45-54 years 22.6%, 55-64 years 23.6%, 65-74 years 26.6% and 75-84 years 32.9%).[2]
A higher proportion of females (21.0%) than males (14.3%) received medication. Residents of Inner regional areas were dispensed psychiatric drugs at the highest rate (22.2%), followed by people in Outer regional areas (20.2%), Major cities (16.5%), Remote (14.9%) and Very remote (8.5%) areas.[3] Among the Australian states, Tasmania had the highest rate of psychiatric medication use (2.3 prescriptions per resident) and New South Wales had the lowest (1.51 prescriptions per resident).
These high rates of psychiatric drug use invite obvious questions: Are Australians benefiting from all this medication use? Or are Australians suffering from a harmful epidemic of psychiatric over-diagnosis and over-prescribing?
[1] Table PBS.2: Number of patients dispensed one or more mental health-related medications, by type of medication prescribed and prescribing medical practitioner, states and territories, 2020–21 Available at https://www.aihw.gov.au/mental-health/topic-areas/mental-health-prescriptions#data
[2] Figure PBS.3: People (per cent) dispensed one or more mental health-related medications, by patient demographics, 2020–21 https://www.aihw.gov.au/mental-health/topic-areas/mental-health-prescriptions#data
[3] See https://www.aihw.gov.au/mental-health/topic-areas/mental-health-prescriptions#summary
Depression, Antidepressant Use and Suicide in Australia
Although Australians rank highly in global happiness ratings, since at least 2000, we have been among the world’s biggest users of antidepressant. Between 1 July 2020 and 30 June 2021, more than 3.5 million Australians of all ages (13.0%) were prescribed an antidepressant.[4]
This included 137,111 Australian children (aged 0-17 years).[5] Through the COVID pandemic, these numbers have grown substantially, especially among young Australians. This is despite the fact that no antidepressant is approved by the TGA for the treatment of childhood depression and all antidepressants carry warnings that they increase the risk of suicidal thoughts and behaviours in depressed people aged under 25 years. Since 2008, the per-capita rates of the use of antidepressants and suicide and self-harm among young Australians have all risen alarmingly, raising concerns that the warnings have been ignored and young people have died as a result.
The vast majority of Australian antidepressant prescribing is done by general practitioners. Some critics contend that GPs lack the depth of mental health training of psychiatrists and psychologists. They contend that this, and other social and economic factors, that have resulted in an increasingly medicalised response to human suffering.
There are also growing concerns about both the efficacy and safety of antidepressants, and their withdrawal effects. Until recently, the dominant theory justifying the use of antidepressants, was that depression was caused by a ‘chemical balance’ involving serotonin. However, this theory has been discredited with many of the proponents and organisations (including the RANZCP) that claimed that antidepressants rebalanced brain chemistry, reluctantly acknowledging it this is wrong.
The role of antidepressants, and the medicalisation of depression, is undoubtedly among the most significant mental health controversies within Australia and globally.... Read more here.
[4] Table PBS.2: Number of patients dispensed one or more mental health-related medications, by type of medication prescribed and prescribing medical practitioner, states and territories, 2020–21 Available at https://www.aihw.gov.au/mental-health/topic-areas/mental-health-prescriptions#data
[5] Table PBS.5: Number of patients dispensed one or more mental health-related medications, by type of medication prescribed, sex and age group, 2020–21 Available at https://www.aihw.gov.au/mental-health/topic-areas/mental-health-prescriptions#data
Attention Deficit Hyperactivity Disorder in Australia
ADHD is Australia’s most frequently medicated childhood psychiatric disorder, and adult medication use rates are rising rapidly. In 2013, ADHD drugs were dispensed to 112,605 Australians. By 2020, 334,000 Australians, including over 219,000 aged <18 years were medicated.
In October 2022, the NHMRC endorsed the Australian Evidence-Based Clinical Practice Guideline for ADHD developed by an organisation with financial ties to drug manufacturers. The claim that the Guideline is ‘evidence based’ is grossly misleading. Only three, of the Guidelines 113 recommendations relating to diagnosis and treatment, are supported by moderately robust evidence.
The lack of evidence supporting the Guideline is emblematic of the dishonest hype promoting ADHD. Although it is routinely described as a neurodevelopmental (i.e. brain) disorder, there are no objective diagnostic tests. Rather, the diagnosis is based on reports of children often exhibiting impulsive and/or inattentive behaviours (fidgeting, losing toys, disliking homework etc.).
Many factors that have nothing to do with biology have been shown to increase the risk of ADHD diagnosis and medication use. For example, the youngest children in a classroom, are much more likely to be diagnosed and medicated than their older classmates.
The most commonly used ADHD medications are Amphetamine Type Stimulants that have similar effects and risks as illicit amphetamines. Indeed, methamphetamine (brand Desoxyn) is prescribed for ADHD in the USA.
When taken in low doses stimulants temporarily sharpen focus in most people irrespective of their ADHD status. Prescribed stimulants are frequently used illicitly for recreational or lifestyle purposes (e.g. binge drinking or managing sleep deprivation).
Stimulants, and less commonly used ADHD drugs (e.g. Strattera), have a range of potential adverse effects, including suicidality. Although there is little research into their long-term impact, troubling evidence indicates that their sustained use is associated with worsening academic performance and other serious adverse outcomes… (Read more here)
Past PsychWatch Australia Blogs
19 September 2022 - College of Psychiatrists takes down false claim that drugs rebalance brain chemistry In September 2022, nine members of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) wrote to their College President requesting that the RANZCP immediately remove a misleading webpage that claimed that antidepressants and other psychiatric 'medications work by rebalancing the chemicals in the brain'. They were concerned that this misinformation 'reflects poorly on the College and seriously misleads consumers'.
The letter appears to have had the desired effect. On Friday 16 September the RANZCP President advised PsychWatch Australia that the misleading webpage 'will be unpublished while a thorough review is conducted’. As detailed in our last blog a letter from the PsychWatch Australia editorial team initially raised the issue with the RANZCP President. Although it would have been better if the RANZCP had never misled consumers, PsychWatch Australia applauds the eventual back-down, and the involvement of the nine RANZCP members.
23 August 2023 - Myth persists at RANZCP - College of Psychiatrists still claims that meds rebalance brain chemicals This blog includes a copy of a letter by the PsychWatch Australia editorial team to the President of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) requesting the removal of misleading information on the RANZCP website, claiming that psychotropic 'medications work by rebalancing the chemicals in the brain'. The letter discussed recent research that demonstrated that there is ‘no [evidentiary] support for the hypothesis that depression is caused by lowered serotonin activity or concentrations’. This research has been widely accepted as finally debunking the myth that depression is caused by a chemical imbalance. Initially the RANZCP declined to remove the misleading claim.
27 June 2022 - Youth suicide risk from antidepressants prompts Health Minister to demand safe treatment guidelines Mounting evidence that taking antidepressants increases the risk of suicide among young Australians has triggered the Albanese Government Health Minister, Mark Butler, to order the development of 'new evidence-based guidelines for their safe use'. The commitment by Minister Butler that new guidelines would be developed by the end of 2022 was reported in the Sunday News Ltd tabloids on 26 June 2022 (see far below).
The catalyst for Minister Butler's intervention was research published in 2020 - Antidepressant Prescribing and Suicide/Self-Harm by Young Australians: Regulatory Warnings, Contradictory Advice, and Long-Term Trends - conducted by the PsychWatch Australia editorial team. Subsequent evidence the TGA, and a MedicineInsight Report, has demonstrated similar patterns i.e. rising long-term trends for both antidepressant use, and completed and/or attempted suicide among young Australians. Although it remains true that a causal link between antidepressant use and completed suicide has not been definitively proven, all the credible independent evidence is pointing in the same direction. PsychWatch Australia will continue to monitor and report on developments.
9 May 2022 - Morrison Government overrules TGA to approve antidepressant manufactured by political donor In September 2020 Australia’s independent medical product safety regulator, the Therapeutic Goods Administration (TGA), rejected an application by Janssen Cilag, the manufacturer of Spravato (a nasal spray containing ketamine), to approve its use for ‘treatment resistant depression’. The TGA decided that there were 'a number of irresolvable methodological issues' with the evidence Janssen Cilag submitted and concluded 'there was a lack of robust data' demonstrating efficacy.
However, in January 2021, the Morrison Government Health Minister Greg Hunt, via a delegate acting on his authority under section 60 of the Therapeutic Goods Act, granted Janssen Cilag's request by overturning the TGA’s decision and approved Spravato. Between July 2016 and June 2020 Janssen Cilag donated at least $147,400 to the Liberal Party (Self-generated report from the Democracy for Sale Website). The total figure could be much higher but because of Australia’s incredibly lax political donation laws we will probably never know the full amount donated.
March 8 2021 - Reviews of Overprescribing Madness - What's driving Australia's epidemic of mental illness? by Dr Martin Whitely
“In Over-Prescribing Madness, Whitely exposes the rhetoric, hype and self-interest, behind Australia's faux-epidemic of mental illness. More importantly, he identifies affordable solutions to ensure those who need help, get help, that is safe and effective.”
Prof Jon Jureidini - Child Psychiatrist University of Adelaide
“Martin Whitely adroitly exposes the drug industry's two big lies - that all human distress is caused by chemical imbalance and there's a pill for every problem. He combines a politician's savvy, a researcher's knowledge, and a writer's eloquence in this valuable book.”
Prof Allen Frances - Chair American Psychiatric Association DSM4 Taskforce
29 October 2020 - Melbourne’s COVID spike in antidepressant use may trigger suicides by children and adolescents. Last month, well before today's easing of Melbourne's lockdown, a group of ten GPs co-signed an open letter to Victorian Premier Daniel Andrews, pleading with him to review his Government’s approach to Covid-19 and “look at what we can reopen safely”. Their letter was driven by their experience of vast increases in the number of severely depressed (sometimes suicidal) children they were seeing. The letter stated the lead author a GP had been seeing “many 12-15 year olds so depressed that I have no other option but to put them on antidepressants”.
There is no doubt that the issues they raised were real. Restrictions were impacting on the wellbeing of young people. However, there are good reasons to question the treatment practices they promote. There is compelling evidence that prescribing antidepressants put these young patients at greater risk of suicide and pouring petrol on an out of control fire is never a good idea.
15 October 2020 - Young distressed Australians put at ultra-high-risk of stigma by $33M pre-psychosis drug research. Led by prominent psychiatrist Patrick McGorry, youth mental health research organisation Orygen has secured $33 million in US funding to breathe new life into McGorry’s three decade long quest to develop a reliable and safe way of identifying young people who are at 'imminent and high' risk of becoming psychotic with the ultimate aim of developing preventative drugs. This sounds like something we should all rally behind, however, the devil is in the detail. In reality, McGorry’s grand plan involves intervening earlier than early, by medicating mildly disturbed young people who have never been psychotic, and most likely if left alone, never will be.
18 June 2020 - Australian Government Health Minister Greg Hunt had instructed his department to conduct a review of research led by PsychWatch Australia's editorial team revealing an alarming link between antidepressant use and youth suicide. Minister Hunt's welcome decision followed significant media coverage of our research and a brilliant speech by Julian Hill MP (the Labor Member for Bruce) in the Australian Parliament calling for an inquiry. It is heartening to see cooperation between politicians from both the governing Liberal Party and the Labor Opposition. It offers real hope of safer prescribing practices and improved outcomes for young Australians. It is anticipated the Minister will release the Review and his response in late 2020.
8 June 2020 – Recently published research led by PsychWatch Australia’s editorial team - Antidepressant prescribing and suicide/self-harm in young Australians: Regulatory warnings, contradictory advice, and long-term trends’- raises concerns about the safety of antidepressant use by young Australians. In 2007 the FDA warned that antidepressant use roughly doubles the risk of suicidal thoughts and behaviours in people aged under 25. However, since 2009, both antidepressant prescribing and suicide rates have risen sharply. The number of suicides by Australians aged 0 to 24 rose steadily from 279 in 2009 to 458 in 2018 and the proportion of Australians aged 0 to 27 using antidepressants grew from about 2.9% to 4.8%. There is also evidence of a substantial increase in rates of self-harm by young Australians, with prescription antidepressants among the drugs most commonly used in self-poisoning.
28 November 2019- Since 2009, the number of Australian child prescribed ADHD medications has more than doubled from approximately 61,000 to an estimated 130,000 in 2019, despite our population increasing by less than 16%. In November 2009 former Australian of the year Professor Fiona Stanley told a conference of Australian politicians that “The vast majority of kids on ADHD drugs are on drugs unnecessarily. They are just naughty little boys and they would have been coped with before but they are now being medicalised”. Apparently, Australia now has many more medicated 'naughty boys', than it did a decade ago.
12 November 2019 - The Productivity Commission’s draft mental health report, includes a bombshell recommendation that threatens the monopoly that headspace has on Commonwealth Government funds for youth mental health services. Apparently even the CEO believes the headspace brand is way ahead of the substance.
14 October 2019 - It is Boom time again for Western Australia's ADHD Industry as WA Health Minister Roger Cook weakens amphetamine prescribing controls. Perth was the world's first child prescribing hot-spot to see a large (50%) decline in child ADHD prescribing rates (between 2002 and 2010). But that happened when WA had politicians that were prepared to take on the ADHD Industry. Now child and adult prescribing rates are rising rapidly, with ample evidence that diverted ADHD stimulants, particularly dexamphetamine, contribute to the state's notorious amphetamine problem.
23 July 2019 - A recent review of drug trials found that the rate of suicide attempts and completed suicides was about 2.5 times higher in those using antidepressants compared to placebo. The blog also demonstrates that Australian (all age) per-capita rates of antidepressant use and suicide rate, both trended upwards from 2012 to 2017. It also details that despite the real world evidence of surging Australian antidepressant use and youth suicide, both Patrick McGorry and Ian Hickie doubled down on their assertion that antidepressants don’t increase the risk of suicide.
27 June 2019 - An open letter to Prime Minister Scott Morrison in regard to antidepressants and youth suicide - Dear Prime Minister, Thank you for making youth suicide a priority for your Government. However, elements of your Government’s policy position (Our Plan for youth mental health and suicide prevention) may entrench the well-meaning, but failed, approaches to youth suicide of the Gillard, Rudd, Abbott and Turnbull Governments. To put it bluntly, if these concerns are not addressed, it is likely more young Australians will self-harm and suicide.
23 June 2019 - This blog Ten truths the ADHD Industry don't want you to know reveals that in 2018 the global sales of ‘ADHD medications’ totalled US$16.4 billion. That is more than the National Income (GDP) of 68 of the 186 countries for which the IMF collected 2018 data. This is a stunning amount given that the core business of the ADHD drug industry is selling amphetamines for use by children. This blog details ten truths the fundamentally dishonest ADHD Industry would rather you didn’t know.
1 June 2019 - More young Australians suicide/self-harm and use antidepressants while 'experts' dismiss FDA warnings - Influential organisations and experts, including Suicide Prevention Australia, headspace, Orygen, and Professors Ian Hickie and Patrick McGorry, have given advice that contradicts FDA and TGA warnings that antidepressant use increases the risk of suicidality in people aged under 25 years. Australia has followed their advice, and child, adolescent and young adult antidepressant use, suicide and self-harm rates have increased alarmingly. It's time to ask if our 'suicide prevention experts' got it horribly wrong and has their advice contributed to the avoidable deaths of young Australians?
8 May 2019 - Drug companies secretly donate to political parties, while sharing in $12.7 Billion of our taxes via the PBS, and hiding product safety data behind a FOI law loophole. Sweeping reforms of our inept Therapeutic Goods Administration, and corruption inducing, PBS, FOI, and political donation disclosure laws, are long overdue.
24 April 2019 - PsychWatch Australia's first blog revealed thar 1 in 8 (over 3 million) Australians were prescribed an antidepressant from July 2017 and June 2018. We aked what is driving this epidemic - real mental illness or a sick system? To see the significant media coverage generated by this blog click here.