Case study
Antidepressants in older adults
The problem
Australians over 65 are disproportionately prescribed antidepressants and remain on them for longer. The average duration of therapy in Australia is approximately 4 years, far exceeding the guideline recommendations of 6 to12 months. Prolonged use increases risks of adverse effects such as sedation, postural hypotension, QT interval prolongation, anticholinergic effects, gastrointestinal toxicity, weight gain and sexual dysfunction.
Research insights
Anxiety, grief, loneliness and depression are aspects of mental health that are more prevalent in older people and are difficult to differentiate. Depression is often viewed as a long-term condition requiring ongoing antidepressant therapy. Following initiation, review and monitoring is not always prioritised. Fears that deprescribing will trigger relapse or withdrawal can result in a clinical trap where prescribers and consumers believe that the benefits of ongoing use outweigh the potential risks of deprescribing.
Approach
We applied implementation science to design a program of education and resources that helps clinicians and consumers understand the risks of prolonged use and avoid ‘set and forget’ prescribing. We mapped targeted interventions across critical phases of the patient journey—diagnosis and initiation, routine review and monitoring, and structured deprescribing and developed clinical tools and training resources to support structured conversations about risks, benefits, safe deprescribing, and evidence-based non-pharmacological alternatives.
Outcomes and highlights
Program interventions have supported a more rigorous process for initiation and monitoring antidepressants and promoting the use of alternative solutions.
Tools training and resources have facilitated more informed conversations about risks benefits, deprescribing and alternative treatments and strategies.
151% of target achieved for consumer resources engagement
97% of participating health professionals reported increased confidence in managing antidepressant use
92% of clinicians committed to change practice.
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