One in seven Australians takes antidepressants. That’s almost four million people. Doctors typically recommend staying on them for six to 12 months after they start to feel better. But many Aussies end up staying on antidepressants for years and even decades.

In fact, more than a third of people prescribed these medications take them for more than a year. Nearly a quarter (24%) take them for more than two years, according to a sample analysis of Australians prescribed through the Pharmaceutical Benefits Scheme (PBS).

Often, patients have a clear prescribing plan when starting antidepressants, but conversations around how and when to stop taking them are much rarer.

Antidepressant researcher, Associate Professor Mark Horowitz, likened this experience to selling a car without brakes.

So, what happens when someone is on antidepressants longer than recommended?

In Australia, the most popular type of antidepressants are SSRIs and SNRIs. Two of the 10 most prescribed PBS drugs in Australia are the SSRIs sertraline (brand name Zoloft) and escitalopram (brand name Lexapro).

SSRI stands for Selective Serotonin Reuptake Inhibitors and SNRI stands for Serotonin-Norepinephrine Reuptake Inhibitors.

SSRIs and SNRIs work by increasing how much serotonin and norepinephrine remain available in the brain, chemicals involved in regulating mood, memory, and alertness. Normally, the brain reabsorbs these chemicals once they've done their job – these medications block that reabsorption, so the effects last longer.

Antidepressants may also be prescribed for anxiety, as well as non-mental health conditions like nausea and migraines.

Stopping antidepressants isn't always as simple as just not taking the next pill. Because these medications change brain chemistry over time, the brain can need time to adjust when they're taken away. This can trigger withdrawal symptoms, such as dizziness, sleep changes, brain ‘zaps’, nausea, irritability, or mood swings, ranging from mild to severe.

A 2018 UK review found that 56% of patients coming off antidepressants reported withdrawal symptoms. A 2020 study led by Swiss researchers noted that 30-50% of those stopping treatment have severe symptoms.

Royal Australian and New Zealand College of Psychiatrists (RANZCP) spokesperson Professor Malcolm Hopwood told me that people can sometimes take withdrawal symptoms as an indicator that “the depression is coming back”.

Some people may have recurring mental health issues and can be recommended antidepressants on different occasions.

“If you've already had multiple episodes of depression, where your risk of relapse stays high for longer, and generally clinicians would continue for longer,” Hopwood said.

However, he added that “there are people who remain on antidepressants for very extended periods without necessarily a great deal of review of that.”

“It becomes a simple sort of pick-up script and kind of a tick-and-flick exercise… I don't think that's great care.”

In Australia, 92% of antidepressants are prescribed by GPs, which Hopwood said makes reviewing a “difficult task”.

For Lee King, these effects weren't statistics – they were part of a five-year journey with antidepressants that started for an unrelated reason entirely.

She began taking the antipsychotic drug olanzapine then the antidepressant amitriptyline around five years ago, as recommended by a gastroenterologist for chronic nausea.

King’s first doctor changed her dosage and took her on and off the medications for three years, which she said “destabilised” her.

She was then prescribed mirtazapine, a non-SSRI antidepressant, “which just made things infinitely worse.”

After eight months, she began tapering off mirtazapine in February 2025 with the support of her current doctor.

You’ve likely heard mental health conditions like depression are caused by a “chemical imbalance”.

This idea became popular through decades of marketing and public messaging, but researchers now say it oversimplifies a much more complex picture. A widely cited 2022 review in Molecular Psychiatry, for example, found no clear evidence that depression is caused by low serotonin levels alone.

An article by Queensland and Adelaide universities published in June investigated long-term antidepressant use, and also addressed this myth.

Professor Mark Horowitz led the research, writing in the article that, while psychiatrists and researchers are in agreement that the chemical imbalance theory is simply not true, much of the public still believes it to be.

This misconception can “reduce self-efficacy and promote unnecessary long-term use.”

Horowitz  told me that when drug companies created antidepressants in the 1980s and 90s, “they amplified that theory.”

“They thought, well, if people think depression's caused by low serotonin and we're selling drugs that increase serotonin, people are gonna think this is a really neat, effective treatment for depression,” he said.

Horowitz paralleled this “fallacy” to the use of painkillers like paracetamol.

“If paracetamol improves a headache, it doesn't mean that headache is caused by low paracetamol,” he said.

Some patients have found that using antidepressants long-term has presented side effects like sexual dysfunction, emotional numbing, insomnia, cognitive impairment, and weight gain.

Both Horowitz and Hopwood pointed to duration and dose as key risk factors – Horowitz noting "the longer someone is on an antidepressant, the harder it is to stop, because of withdrawal effects," with Hopwood adding that harsh symptoms are "more likely" for those who've been on a high dose for a long time.

A group of psychiatrists responding to Horowitz's article agreed antidepressants should be reviewed regularly, but argued some patients may need continued treatment.

They also disagreed with some of the evidence used, including the limits of using previous studies as “generalisable to an Australian general practice population”.

Horowitz supports hyperbolic tapering, very gradually decreasing dosage, and in 2024 published this method as the Maudsley Deprescribing Guidelines.

“You go down by smaller and smaller amounts down to these very final, small doses.”

This can require patients to find compound pharmacies or even create suspensions themselves with small dosages. 

The Royal Australian College of General Practitioners (RACGP) has endorsed this practice.

Horowitz said that while he knows “how overworked” GPs are, “it would be worth reading about the latest evidence on slower tapering.”

“I hope GPs become more accustomed to this practice as time goes on,” he added.

Pharmacist Alicia Martin started TaperMate, a free calculator and subscription-based app to help patients taper from antidepressants.

The idea came from patients telling her they missed their medication and were having withdrawal symptoms which seemed to go away “as soon as they took the dose”.

“It kind of highlighted to me that antidepressant withdrawal was maybe a bit more severe than I had initially thought,” she said.

Hopwood has encouraged readers who may resonate with these experiences to have continual conversations with their healthcare providers around what treatments might suit them.

This was echoed by Horowitz, who told me in the "modern era of medicine" decision-making is "shared" and "supported".

"Patients should be empowered," he said.

Changes to medication, including stopping or altering dosages, should always be done with the express guidance of a healthcare professional. Decisions around medication usage should be made with the support of a doctor.

Help is available. Reach out to Lifeline on 13 11 14, or you can chat to someone online here.

Disclosure: Prof Mark Horowitz receives royalties from the Maudsley Deprescribing Guidelines and is involved in a U.S. antidepressant tapering clinic.

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