Hayden Lee, 42627854

ASSIGNMENT COVER SHEET

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COURSE DETAILS
Course Code: MEDI4022

Course Name: Scholarship of Research

Course Co-ordinator:
Angela Wallace

Assignment No: 3
Assignment Due Date: 3 June 2016 by 11;59PM
Brisbane time (AEST)

STUDENT CONTACT DETAILS

Student Number: 42627854

Student Name: Hayden Lee

Address: 1/25 Maynard St, Woolloongabba, QLD 4102

Email Address: hayden.lee@uq.net.au

Program: MBBS Degree

Mobile:

0406 778 654

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Date: 12 June 2016

Hayden J Lee

Due Date: 12 June 2016

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Hayden Lee, 42627854

MEDI4022 Assignment 3 Research Commentary

Please fill in the boxes below
Topic number:
Topic name:

10
Increased prescribing of
antidepressant medication

Name of destination journal you

have chosen:

MJA

Insert a copy of the URL link to your destination journals author instructions page:
https://www.mja.com.au/journal/mja-instructions-authors
Word count: 915
(do not include coversheet or references in your word count)

Insert your letter to the Editor on the next page

Hayden Lee, 42627854

Research commentary regarding treatment trends of

depression in the context of Australias Better Access
program
Much attention is paid to the overprescription of antibiotics or the costly practice of overservicing and
testing, and rightfully so in a world of increasing health risks and resource use. With the ever growing
stressors of modern life, however, a shift in focus onto Mental Health has come to the fore. The past decade
has seen a dramatic increase in the dispensation of psychotropic drugs in Australia, primarily
antidepressants. This has led some to ask: are we going beyond appropriate levels of antidepressant
prescription?
In order to evaluate the appropriateness of the trends in antidepressant prescription, we must account for a
number of factors. In particular, one must carefully consider the impact of the Better Access program in
Australia. This initiative, established in 2006, aimed to increase access to mental health services both by
making it more affordable and also thus in turn attempting to remove stigma from mental health. By
including psychological treatment services in Medicare funding, mental health became readily accessible for
many patients who needed it, also opening a dialogue in the general population that served to increase
awareness of, and decrease stigma towards, seeking help for mental health disorders.
Although this is undeniably a positive step, has pharmacotherapy for depression stepped into the realm of
overprescription? The key questions one must ask are what might be some reasons behind the increased
prescription rate, is there harm arising from the increase and are there more effective options?

What are the numbers?

Stephenson et al. (2012) examined trends in Australian prescription of psychotropic medications between
2000 and 2011. They concluded that there had been a 95.3% increase in the populations daily dose of
antidepressants (Defined Daily Doses/1000 population/day).
During a similar timeframe, however, from 2006 to 2013, there was also marked evidence of increased
psychological treatment rates for mental disorders, according to the 2013 report by the Australian
Psychological Society. Following the introduction of the Better Access initiative, 81% of the 19.6 million
patients who accessed mental health services under the scheme had a disorder that involved depression
and/or anxiety.
It is not stated exactly how much of this increased treatment involved pharmacotherapy, however.
Although there have been numerous studies extoling the virtues of psychotherapy and in particular cognitive
behavioural therapy (CBT) and comparing different rates of pharmacotherapy use increase (for instance
different classes of antidepressants), there appears to be a paucity of research comparing the increased
prescription of antidepressants with the rate of CBT or other non-pharmacological therapies for depression.

Hayden Lee, 42627854

Why is this happening?
Although no studies have been done specifically on whether there is a link between the increased usage of
mental health services from the Better Access program and prescription rates, the increased treatment rate
would have inevitably resulted in some increase in the level of pharmacotherapy in the form of
antidepressants. This is not only due to nearly a third of the services provided through the initiative being
from GP Mental Health treatment plans, but also due simply to the increased awareness and, as the name
suggests, access. The role of the Better Access program in increasing the high uptake of psychology services
in the community cannot be underestimated, and as more patients with mood disorders are willing and able
to seek treatment, more antidepressants are going to be prescribed.
The increase in prescription of antidepressants is not a trend isolated to Australia, however; it is an
international trend that has also been evident in several countries. By looking at a couple of examples of
attempts to explain the rise in these other countries, we can speculate as to whether there are similar causes
in Australia.
In 2009, Moore et al. sought to explore the reasons behind increases in antidepressant prescribing in the UK.
They came to the conclusion that changes were the result of an increased focus of treatment towards patients
on long-term therapy, though Spence (2013) disagreed with the notion that this was the sole cause.
In May 2016, Wong et al. examined the treatment indications for antidepressants in Canada from 2006
2015. Their conclusion was that off-label, non-depressive indications such as insomnia and pain were
another plausible contributor to the increased trend.
It is not unreasonable to suspect that a combination of all of these factors could be contributing to the trend
in antidepressant prescription being seen in Australia.

Hugs or drugs?
Is this a problem? A large issue in regards to the use of antidepressants is determining its efficacy in
treatment. Numerous studies and guidelines have outlined that antidepressants have no role in treating mild
depression. Stephenson et al. also raised concerns over the increased use of serotonin-norepinephrine
reuptake inhibitors which have a more complicated side effect profile, potentially even leading to greater
harms rather than positive effect.
So what should be done?

Hayden Lee, 42627854

Figure 1: Non-pharmacological strategies for treating mild depression, as recommended by the National
Prescribing Service guidelines (Orman, 2016)
68% of the service provision through Better Access was in fact noted to be from psychologists providing
non-pharmacological treatments. These are strongly recommended in all levels of depression severity, only
concurrently adding pharmacotherapy in severe cases.
Ultimately, although there may not necessarily be as great a cause for alarm in regards to overprescription of
antidepressants as first meets the eye, greater encouragement of non-pharmacological therapies, especially
for non-severe depression, should still be recommended to both treating clinicians and to the general
populace, rather than leaping straight to pharmacotherapy.
915 words (Word limit: 1000 words)

Hayden Lee, 42627854

References

Littlefield L. (2014). Seven Years of Better Access: Consumers show benefits from an effective,
affordable and destigmatising mental health reform. Australian Psychological Society.
Retrieved 12 June, 2016, from https://www.psychology.org.au/Assets/Files/2013-BetterAccess-APS-report.pdf
Moore M, Yuen HM, Dunn N, Mullee MA, Maskell J & Kendrick T. (2009). Explaining the rise in
antidepressant prescribing: a descriptive study using the general practice research database.
BMJ (Clinical research ed), 339(B3999)
Orman J. (2016) Exploring non-drug options in depression MedicineWise News. Retrieved 12
June, 2016, from
Reid IC. (2013) Are antidepressants overprescribed? No. BMJ (Clinical research ed),
346(f190)
Spence D. (2013) Are antidepressants overprescribed? Yes. BMJ (Clinical research ed),
346(f191)
Stephenson CP, Karanges E & McGregor IS. (2013) Trends in the utilisation of psychotropic
medications in Australia from 2000 to 2011. Aust & NZ J of Psychiatry, 47(1)