Zoloft enters list of 10 most commonly prescribed drugs in Australia
An increase in women being diagnosed with depression is partly behind a significant rise in prescriptions of the antidepressant sertraline – sold under the brand name Zoloft – which is in the list of Australia’s most commonly prescribed drugs for the first time.
On Tuesday Australian Prescriber published its annual list of the 10 most commonly taken drugs – based on standard daily doses for every 1,000 people in the population each day – along with a list of the 10 most costly drugs to government, and the 10 most common drugs by prescription counts.
The data was collected between July 2019 and June 2020. The top drugs by daily dose per thousand in the population is the most useful measure of drug usage rather than prescription counts, because the supply of medication in each prescription changes over time.
The first eight drugs are all used to treat and prevent heart disease and stroke. The top two most commonly taken drugs by Australians are both statins, which are cholesterol-lowering drugs taken by people at risk of cardiovascular disease. A range of drugs used to treat hypertension, a risk for stroke and heart attack, made up the rest of the top eight. Heart disease is the leading underlying cause of death in Australians.
Metformin, used to control blood sugar levels in people with type 2 diabetes, came in at number 10. Diabetes contributes to more than 10% of deaths in Australia each year.
Sertraline entered the top 10 for the first time, coming in at number nine. Almost 26 doses of the drug are taken each day per 1,000 Australians, the data shows.
The director of the Monash Alfred psychiatry research centre, Prof Jayashri Kulkarni, said she was not surprised to see sertraline enter the list.
“Zoloft is one of the starter drugs for depression, so it means it is often prescribed to people presenting with depression for the first time, and it has also been shown to be clinically useful for anxiety,” she said.
“We are seeing more people experiencing a major depressive disorder for the first time, and anxiety requiring medical treatment, and Covid has accelerated some people from a subclinical depression into a clinical condition that needs stronger treatment.”
Women in particular were being affected, Kulkarni said.
“What we are seeing is women across all demographics who have experienced trauma in their life, such as an abusive childhood, sexual abuse, an abusive relationship, family violence or bullying,” she said.
“They will get through all of that, but these traumatic life events seem to make the individual more vulnerable later if they have a difficult relationship, or difficulty in the workplace. This accumulative collection of trauma and stresses can set women up for terrible health outcomes.”
But Kulkarni said she was concerned people were being prescribed sertraline too readily, without also attending psychology sessions. Medication alone was often not enough to reliably treat depression in the long term, she said.
“Getting Zoloft will be a small part of addressing the issue but women also need good psychotherapy to deal with trauma and to re-empower them,” she said. “She must heal from the earlier trauma, and feel empowered to have better self-esteem and make better choices for next relationships or careers.
“It’s a complex picture, but sometimes people don’t have enough time for the therapy, or they don’t have private health insurance, or the wait list is too long, or it’s too expensive, and by comparison, Zoloft seems cheap and easy. But it won’t cover all bases.”
The most costly drug to the federal government in 2019-20 was aflibercept, most commonly used to treat wet macular degeneration, a chronic eye disorder that, if left untreated, can cause blindness. The drug cost the government more than $392m.
Dr Peter Sumich, the president of the Australian Society of Ophthalmologists, said the drug was injected into the eye by a trained specialist and needed to be given monthly for the rest of a person’s life.
“People with macular degeneration have developed bleeding of blood vessels, and it is a condition associated with age,” he said. “The drug dries up the blood but after about a month it wears off, so once you’re on it you need to keep going back to the doctor every month.”
He said the cost to government reflected a growing ageing population.
“Twenty years ago, we didn’t have drugs to treat the condition and people would go blind within a few months,” Sumich said. “The good news is some drugs are coming out that are longer acting, and can be used every six weeks or three months, and there are also slower-release drugs in development.
“Hopefully, that means we are now at peak injection volume and in years to come we can do fewer injections as these newer drugs are released.”
