{"id":30450,"date":"2025-07-29T06:35:10","date_gmt":"2025-07-29T06:35:10","guid":{"rendered":"https:\/\/www.newsbeep.com\/uk\/30450\/"},"modified":"2025-07-29T06:35:10","modified_gmt":"2025-07-29T06:35:10","slug":"why-are-so-many-teens-prescribed-high-dose-antidepressants","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/uk\/30450\/","title":{"rendered":"Why are so many teens prescribed high-dose antidepressants?"},"content":{"rendered":"

\"antidepressants\"<\/a><\/p>\n

Mental health needs are rising, but so are questionable prescribing patterns. Pharmacists can help define the line between justified care and risky overreach.<\/p>\n

Australia\u2019s adolescent mental health crisis is escalating at a troubling pace. A landmark longitudinal study by Murdoch Children\u2019s Research Institute<\/a> revealed that by age 18, nearly three quarters (74\u202f%) of Australian teenagers experienced clinically significant symptoms of anxiety or depression at least once \u2013 with many enduring chronic episodes spanning multiple school transitions and exam periods.\u00a0<\/p>\n

The Australian Bureau of Statistics confirms that in 2020\u201322, 38.8\u202f% of 16\u201324\u202fyear\u2011olds reported a mental disorder in the past 12 months<\/a>, dominated by anxiety (17.2\u202f%). Contributing factors are complex: academic pressure, early puberty, growing social isolation, socioeconomic stress, and particularly, the impact of social media.<\/p>\n

The increase in prescribing<\/p>\n

Similarly, antidepressant prescribing among Australian adolescents is on the rise, raising concerns about off-label use and high-dose regimens \u2013 with the pharmacist\u2019s role in ensuring safe and appropriate therapy more important than ever. A 2024 ABC report noted that psychotropic use in under\u201118s more than doubled<\/a> from 2013 to 2023.3\u00a0<\/p>\n

Between 2013 and 2019, Selective Serotonin Reuptake Inhibitor (SSRI) prescribing in adolescents steadily climbed<\/a>, with GPs accounting for 55\u202f% of prescriptions in 12\u201314\u202fyear\u2011olds and 78\u202f% in 15\u201317\u202fyear\u2011olds.\u00a0<\/p>\n

According to consultant pharmacist Amanda Fuller, Clinical Lead at Medcast, the increase in antidepressant prescribing reflects a complex mix of demand, access issues, and public perception.\u00a0<\/p>\n

\"antidepressants\"Amanda Fuller<\/p>\n

\u2018We\u2019re seeing a growing awareness of mental health in young people, which is a positive shift,\u2019 Ms Fuller said. \u2018But when that\u2019s combined with long waitlists for psychologists and psychiatrists, GPs often feel pressure to act quickly \u2013 particularly if there are concerns about deterioration or safety.\u2019\u00a0<\/p>\n

This urgency is sometimes reinforced by family expectations. \u2018Parents and carers may see antidepressants as a fast-acting solution while they wait for psychological support,\u2019 she added.<\/p>\n

Off-label use in high doses<\/p>\n

Most prescribing for under-18s is off-label, which complicates matters, Ms Fuller said.<\/p>\n

\u2018This places the responsibility on prescribers to weigh clinical judgment and available evidence against regulatory guidance.\u2019\u00a0<\/p>\n

In Australia, only fluvoxamine and sertraline are approved by the Therapeutic Goods Administration<\/a> (TGA) to treat obsessive-compulsive disorder (OCD) \u2013 in children aged 6 and 8 years and older, respectively. Others are used beyond their approved indications.\u00a0<\/p>\n

Fluoxetine remains the most commonly prescribed antidepressant in this cohort. \u2018It\u2019s the recommended first-line SSRI for adolescents and is the only one with consistent trial evidence showing efficacy over placebo in depression,\u2019 Ms Fuller said. \u2018But even then, the benefit was modest, placebo response rates were high, and study quality was poor, making interpretation difficult.\u2019\u00a0<\/p>\n

In anxiety, the data is even less robust. \u2018There\u2019s limited evidence, though fluoxetine, fluvoxamine, and sertraline have shown some benefit in trials. But again, quality is a concern,\u2019 she said.\u00a0<\/p>\n

Public understanding of antidepressants is also often shaped by outdated ideas, Ms Fuller said. \u2018The \u201cchemical imbalance\u201d theory has been largely debunked, but it still drives the belief that medication is essential for treatment.\u2019<\/p>\n

More concerning is the increasing use of high-dose antidepressant regimens, sometimes exceeding standard adult doses.\u00a0<\/p>\n

\u2018We know higher doses are sometimes used in OCD, and prescribers may consider the adolescent\u2019s physical maturity. But there\u2019s no strong evidence to support routine high-dose use in this age group,\u2019 she said.<\/p>\n

Psychiatrists are more likely than GPs to prescribe these higher doses, often in complex or treatment-resistant cases. However, efficacy data for higher doses is lacking \u2013 even in adult populations.\u00a0<\/p>\n

\u2018In fluoxetine studies, response rates were actually highest between 20\u201340\u202fmg daily,\u2019 Ms Fuller said. \u2018Going beyond that was linked to more [adverse] effects and increased dropout rates.\u2019<\/p>\n

The role of pharmacists<\/p>\n

Pharmacists should take a proactive yet respectful approach when faced with uncertainty around an antidepressant prescription, Ms Fuller advised.<\/p>\n

\u2018If something doesn\u2019t add up \u2013 if you can\u2019t confirm the indication, or there\u2019s limited information about the treatment plan \u2013 it\u2019s absolutely appropriate to contact the prescriber,\u2019 she said.<\/p>\n

Before doing so, she recommends checking key factors: \u2018Clarify the diagnosis, assess for any psychosocial supports in place, confirm adherence and tolerance, and look at what the follow-up plan involves.\u2019\u00a0<\/p>\n

When contacting prescribers, Ms Fuller urges pharmacists to approach conversations with collaboration, not correction. \u2018Assume clinical reasoning is there \u2013 your role is to clarify, not challenge,\u2019 she said \u2018Focus on shared care, not prescription policing.\u201d\u2019<\/p>\n

Australia\u2019s adolescent mental health situation demands attention and pharmacists have a pivotal role in it. Soaring rates of depression, anxiety and antidepressant prescribing underscore the need for thoughtful, patient-centred care.\u00a0<\/p>\n

PSA25\u2019s session on \u2018Dosing dilemmas\u2019, presented by Ms Fuller, offers essential guidance on navigating adolescent antidepressant use \u2013 from informed dosing choices to structured monitoring and collaborative decision-making.\u00a0<\/p>\n

Haven\u2019t registered for PSA25 yet? Don\u2019t miss your chance \u2013\u00a0registrations are still open<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"Mental health needs are rising, but so are questionable prescribing patterns. Pharmacists can help define the line between…\n","protected":false},"author":2,"featured_media":30451,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[42],"tags":[18778,13883,102,18779,6591,1906,8534,18780,18781,18782,18783,56,54,55],"class_list":{"0":"post-30450","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-medication","8":"tag-adolescent-mental-health","9":"tag-antidepressants","10":"tag-health","11":"tag-high-dose-antidepressants","12":"tag-medication","13":"tag-mental-health","14":"tag-ocd","15":"tag-off-label","16":"tag-psa25","17":"tag-ssris","18":"tag-therapeutic-goods-administration-tga","19":"tag-uk","20":"tag-united-kingdom","21":"tag-unitedkingdom"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts\/30450","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/comments?post=30450"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts\/30450\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/media\/30451"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/media?parent=30450"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/categories?post=30450"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/tags?post=30450"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}