In 2024–25, 3.82 million Australians — nearly one in seven — were dispensed an antidepressant. They included 168,451 children and adolescents, despite no antidepressant being approved in Australia for treating depression in people under 18. (For age-specific detail click here)

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This is not new. Since at least 2000, despite our prosperity, relative equity and obvious lifestyle advantages, Australians have consistently been among the world’s biggest users of antidepressants.[1] [2] The increasing medicalisation of sadness and worry as clinical depression and anxiety, the safety and efficacy of antidepressants, and the relationship between antidepressant use and suicide, are undoubtedly among the most significant mental health controversies within Australia.

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How is depression diagnosed in Australia?

Since it was published by the American Psychiatric Association in 2013, DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders 5th edition) has been adopted by the Australian medical and psychiatric profession as the model for diagnosing depression and other psychiatric disorders. This was done with little public scrutiny of how its expanded diagnostic boundaries might affect Australians.

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The same lack of scrutiny occurred when the previous version, DSM-IV was published in 1994. DSM-5 expanded the diagnostic boundaries for many psychiatric disorders. As a result, people who (before DSM-5) were classified as essentially well now qualify for a diagnosis of a psychiatric disorder. For example, DSM-IV required that following the death of a loved one the symptoms of major depressive disorder last more than 2 months, whereas DSM-5 only requires the symptoms to last for at least two weeks. Each successive version of the DSM has involved similar 'diagnostic creep' (loosening of diagnostic criteria or adding new disorders). The DSM-5 diagnostic criteria for depression are available by clicking here. 

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Who Prescribes Antidepressants to Australians?

Most antidepressant and mental health drug prescribing in Australia is done by general practitioners. In 2024–25, GPs issued 81% of all mental health-related prescriptions and were the majority prescribers for every major category except ADHD-related drugs. GPs reported spending an average of 19.7 minutes with each patient in 2025, during which they may need to assess and manage mental health concerns alongside other health problems and competing clinical demands.[18] [19] Some critics contend that GPs lack the depth of mental health training of psychiatrists and psychologists. They contend that this, together with other social and economic factors, has resulted in an increasingly medicalised response to human suffering. ​​​​​​​

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Australia’s alarming history of antidepressant use, and suicide and self-harm among young people

Antidepressants were dispensed to 444,228 Australians aged 0-24 in the 2024-2025 financial year. This included 168,451 minors (0-17) and 276,196 Australians aged 18 to 24 years. This is despite the fact that all antidepressants carry warnings that they increase the risk of suicidal thoughts and behaviours in depressed people aged under 25 years.[4] Australian Therapeutic Goods Administration (TGA) approved Product Information documents for health professionals and Consumer Medicine Information documents for patients contain warnings about this risk. They advise patients and caregivers to monitor closely for worsening symptoms and suicidal thoughts.[5] [6]

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Antidepressant suicidality warnings were first issued in the USA by the Food and Drug Administration (FDA) in 2004 and in Australia by the TGA in 2005. These initial warnings were based on clinical trial evidence that among people aged under 25 years with depression there was an approximately doubled risk of suicidal thinking and behaviours among those who had taken antidepressants.

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As is detailed in research led by the PsychWatch Australia editorial team published in Frontiers in Psychiatry in 2020 these warnings were followed by a fall of approximately 32% between 2004 and 2008 in the use of antidepressants by young Australians (aged 0-27 years). This period saw a modest 5% decline in the suicide rate among Australians aged under 25 years. However, there was considerable debate, and at times emotive backlash against the warnings by antidepressant proponents in academic journals and the international media.

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Prominent US and Australian mental health organisations and psychiatrists challenged the FDA and TGA warnings arguing that, on balance, antidepressant use was likely to reduce the risk of suicide. Several ecological studies were cited misleadingly as evidence that decreasing antidepressant use increases suicide risk.[7] The backlash appears to have been successful as it was followed by increased antidepressant prescribing to young Australians.

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Our research demonstrated that ‘from 2008 to 2018, Australian per-capita child, adolescent and young adult antidepressant dispensing (0–27 years of age) and suicide (0–24 years) rates have increased approximately 66% and 49%, respectively’. In addition, we found evidence of rising rates of intentional self-harm among young Australians ‘often by intentionally overdosing on the very substances that are supposed to help them’.​​ 

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While acknowledging that a ‘causal relationships cannot be established with certainty until there is a vast improvement in post-marketing surveillance’ we argued that the evidence in our paper warranted serious investigation. We concluded our ‘results do not support claims that increased antidepressant use reduces youth suicide risk. They are more consistent with the FDA warning and the hypothesis that antidepressant use increases the risk of suicide and self-harm by young people’.[7]

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Our research attracted media interest and prompted parliamentary discussion and subsequent action by Australian Government health ministers Greg Hunt (Liberal) and his successor Mark Butler (Labor). At their request the TGA undertook a safety investigation into antidepressant use and suicide risk in young people. The TGA’s report published in 2021 identified that our research was the catalyst for the investigation, however it mischaracterised our paper by implying we had claimed to prove a causal relationship.[8]

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Despite this minor error it was a constructive forward step. The TGA used more detailed PBS data from the Department of Health’s Enterprise Data Warehouse and extended the analysis by an additional year to 2019 and reproduced the same broad pattern reported in our research. It found that suicide rates among Australians aged under 25 had increased between 2009 and 2019 and that antidepressant dispensing rates among young Australians had also “increased steadily”.

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Although causation had not been established, it has become increasingly obvious that the promotion of antidepressants as a youth suicide prevention measure by ‘expert’ organisations and individuals (most notably Suicide Prevention Australia, The Royal Australian College of General Practitioners (RACGP) and prominent Australian depression expert Professor Ian Hickie) was highly questionable. It is even possible that advice downplaying the FDA and TGA suicidality warnings ‘may have contributed to increasing antidepressant use, and thereby possibly inadvertently contributed to rising suicide rates among young Australians.’ [9] ​

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The end of the promotion of antidepressants as a youth suicide prevention measure

Since our paper and the TGA response was published the overt promotion of antidepressants as a population-level suicide-prevention measure has largely disappeared from contemporary Australia national suicide-prevention policy. Major organisations now emphasise social determinants, crisis support, safety planning, aftercare and restricting access to lethal means.

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The College of General Practitioners (RACGP) whose leadership had previously promoted antidepressants as effective suicide prevention measure now expressly states that antidepressants are intended to improve depression or anxiety symptoms, not to prevent suicide per se, and acknowledges that SSRIs may increase suicidal ideation in adolescents.[10] However, a less explicit medicalised narrative persists: depression is routinely treated as a central pathway to suicide, expanding access to clinical treatment is characterised as suicide prevention, and antidepressants continue to be promoted as effective treatment for moderate-to-severe depression. 

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Childhood antidepressant use part of Australia’s rapidly expanding paediatric psychiatric drug use

Hundreds of thousands of Australian Children and Adolescents take antidepressants not approved for <18 use - This figure includes 168,451 Australians aged 0 to 17 years even though no antidepressant is approved for use in the treatment of depression in Australian children and adolescents.[3] This off-label antidepressant use is part of a broader pattern of alarming childhood and adolescent psychiatric medication use with 457,870 Australians aged under 18 years dispensed at least one mental health drug in the 2024-2025 financial year. This figure includes 3,798 pre-schoolers (0.3% of Australians aged 0-4 years), 195,938 primary schoolers (8.6% of Australians aged 5-11 years) and 258,133 (12.8%) of Australians aged 12-17 years.

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Note: In 2024-2025 Amphetamine-Type-Stimulants for ADHD were the most frequently dispensed psychiatric drugs to minors (349,495 Australians aged 0-17 years). For further detail of the psychiatric drugs dispensed to all Australian age-groups see the table on the PsychWatch Australia front page.

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Other emerging concerns about widespread antidepressant use

As well as the relationship between antidepressants and suicide, there are also growing concerns about the efficacy, safety, sexual dysfunction and withdrawal effects of antidepressants. Although a major 2018 network meta-analysis found that antidepressants were more effective than placebo for acute major depression in adults, it also described the average effect sizes as “mostly modest”.[11]

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Antidepressant-induced sexual dysfunction is well recognised, and in 2024 the TGA updated Australian Product Information documents for SSRIs and SNRIs to warn that sexual dysfunction may persist after treatment is stopped.[12] Withdrawal effects have also attracted increasing clinical attention, with the Royal College of Psychiatrists now warning that stopping antidepressants can cause withdrawal symptoms that may be mistaken for relapse.[13] For decades, antidepressant use was popularly justified by the claim that depression was caused by a “chemical imbalance”, usually involving serotonin. That theory has now been widely challenged. A major umbrella review published in Molecular Psychiatry concluded there was “no consistent evidence” of an association between serotonin and depression, undermining the simplistic explanation that antidepressants work by correcting a known brain-chemistry defect.[14]

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The role of antidepressants — and the broader medicalisation of depression — is therefore one of the most important mental health controversies in Australia and internationally. The central question is not whether antidepressants ever help anyone. It is whether Australia has allowed a limited and risky treatment to become a default response to distress, including among children and young people, without adequate evidence, informed consent, monitoring, or investment in safer social and psychological alternatives.

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While the recent increased recognition of harms associated with antidepressants is welcome, these improvements fall well short of what is required. A genuinely cautionary approach to antidepressant use would probably result in a lot less than 3.8 million Australians prescribed antidepressants. We certainly would not have 168,451 Australian children (aged 0-17) on drugs that are not approved for use by children.

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Other facts about depression and antidepressant use in Australia

• Among those aged 65 and over, antidepressants are often "used to treat... anxiety disorders, chronic pain and some types of urinary incontinence".[15]

• Although antidepressant prescribing rates are much lower among younger Australians they are rising rapidly among young Australians. Between 2012-13 and 2017-18, they grew faster among children (+36%) than any other age group (all ages +10%).

• The Australian Atlas of Healthcare Variation, using 2013–14 dispensing data, reported that antidepressants prescribed to children appeared to be used primarily for anxiety rather than depression. More recent national dispensing datasets do not routinely link prescriptions to diagnoses, so it is unclear whether this prescribing pattern has continued.[16]

• The latest Australian Institute of Health and Welfare data, covering 2024–25, show large geographical differences between antidepressant use rates. This variation may partly reflect differences in population age, socioeconomic circumstances, mental-health needs and access to services; however, it may also indicate differences in prescribing practices of local doctors.[17]

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References

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[1] OECD. Health at a Glance 2007: OECD Indicators. OECD Publishing, 2007, Chart 4.15.2 “Antidepressants consumption, DDD per 1,000 people per day, 2000 and 2005.” Available at: OECD Health at a Glance 2007.

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[2] OECD, Health at a Glance 2025: OECD Indicators, “Pharmaceutical consumption”, Figure 9.6, and OECD Data Explorer, Pharmaceutical market, antidepressants/N06A, defined daily doses per 1,000 inhabitants per day, 2023 or nearest year.

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[3] Therapeutic Goods Administration, “SSRI antidepressants: Actions by the Therapeutic Goods Administration concerning use of antidepressants in children and adolescents”, 15 October 2004. The TGA states: “None of the SSRIs, and indeed no antidepressant, is currently approved in Australia for the treatment of MDD in children and adolescents (persons aged less than 18 years).”

 

[4] Spielmans GI, Spence-Sing T and Parry P (2020) Duty to Warn: Antidepressant Black Box Suicidality Warning Is Empirically Justified. Front. Psychiatry 11:18. doi: 10.3389/fpsyt.2020.00018

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[5] Therapeutic Goods Administration. Antidepressant use and youth suicide. Australian Government Department of Health, 20 January 2022.

 

[6] Therapeutic Goods Administration. Antidepressant utilisation and risk of suicide in young people: Safety investigation. Version 2.0, April 2021, pp. 6 and 32–33.

 

[7] Whitely M, Raven M and Jureidini J (2020) Antidepressant Prescribing and Suicide/Self-Harm by Young Australians: Regulatory Warnings, Contradictory Advice, and Long-Term Trends. Front. Psychiatry 11:478. doi: 10.3389/fpsyt.2020.00478

 

[8] Therapeutic Goods Administration. Antidepressant utilisation and risk of suicide in young people: Safety investigation. Published 28 April 2021.

 

[9] Whitely M, Raven M and Jureidini J (2020) Antidepressant Prescribing and Suicide/Self-Harm by Young Australians: Regulatory Warnings, Contradictory Advice, and Long-Term Trends. Front. Psychiatry 11:478. doi: 10.3389/fpsyt.2020.00478

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[10] Royal Australian College of General Practitioners. Suicide: Recognising & responding to risk. In: National Guide to a Preventive Health Assessment for Aboriginal and Torres Strait Islander People. RACGP. Accessed 21 July 2026.
https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/national-guide/mental-health/suicide-recognising-responding-to-risk

 

[11] Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet. 2018;391(10128):1357–1366. The authors concluded that all antidepressants studied were more efficacious than placebo, but that “summary effect sizes were mostly modest.”

 

[12] Therapeutic Goods Administration. Updated warnings about persistent sexual dysfunction for antidepressants. 23 May 2024. The TGA stated that sexual dysfunction is a known risk of SSRIs and SNRIs and that Product Information documents were being aligned to reflect reports of sexual dysfunction persisting after drug cessation.

 

[13] Royal College of Psychiatrists. Stopping antidepressants. The RCPsych guidance states that stopping antidepressants can cause withdrawal symptoms and that some withdrawal symptoms can resemble the original symptoms for which the antidepressant was prescribed.

 

[14] Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA. The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry. 2023;28:3243–3256. First published online July 2022. The review concluded that the main areas of serotonin research provide “no consistent evidence” of an association between serotonin and depression, and “no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations.”

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[15] Australian Commission on Safety and Quality in Healthcare (ACSQHC), Website of the First Australian Atlas of Healthcare Variation 2015, Section 4 Interventions for mental health and psychotropic medicines Subsection 4.4 Antidepressant medicines dispensing 65 years and over. Available at https://acsqhc.maps.arcgis.com/apps/MapJournal/index.html?appid=398ebb592c0a40cf913814bd7b965546# (accessed 15 April 2019)

 

[16] ACSQHC, Website of the First Australian Atlas of Healthcare Variation 2015, Section 4 Interventions for mental health and psychotropic medicines Subsection 4.2 Antidepressant medicines dispensing 17 years and under. Available at http://acsqhc.maps.arcgis.com/apps/MapJournal/index.html?appid=398ebb592c0a40cf913814bd7b965546# (accessed 15 April 2019)

 

[17] Australian Institute of Health and Welfare. Mental health-related prescriptions, 2024–25: Regional activity data. Canberra: AIHW; 2026.

 

[18] Australian Institute of Health and Welfare. Mental health-related prescriptions. Canberra: AIHW; updated 12 May 2026. In 2024–25, 81% of mental health-related prescriptions were issued by GPs; antidepressants represented 70% of prescriptions and were dispensed to 14% of Australians.

 

[19] Royal Australian College of General Practitioners. General Practice: Health of the Nation 2025. Melbourne: RACGP; 2025. The average time GPs reported spending with each patient was 19.7 minutes.