Lessons from the Netherlands for Australia: cross-country comparison of trends in antidepressant dispensing 2013-2021 and contextual factors influencing prescribing

Background There is concern internationally about increasing antidepressant use. Most antidepressants are prescribed in general practice. The aim of this study was to compare trends in antidepressant dispensing in Australia and the Netherlands over the 9 years from 2013 to 2021, and to explore reasons for differences.Methods A convergent mixed methods study including analysis of publicly available antidepressant dispensing data obtained from Australia's Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme and the Dutch Foundation for Pharmaceutical Statistics and a search of relevant literature to compare contextual factors influencing prescribing were undertaken.Results In 2013, antidepressant dispensing rates in Australia were nearly twice as high as those in the Netherlands (82.5 versus 44.3 DDD/1000/day) and increased to be more than twice as high by 2021 (115.6 versus 48.8 DDD/1000/day). Antidepressant dispensing increased by 40% in Australia over the nine study years, but by only 10% in the Netherlands. Our scan of the literature confirms that while population factors, health system structure, and clinical guideline recommendations are largely consistent across the two countries, a multifaceted approach in the Netherlands involving improved access to non-pharmacological alternatives, initiatives targeting safer antidepressant prescribing, and tight regulation of pharmaceutical industry influence on prescribers, has successfully curtailed increasing antidepressant use.Conclusions Australia may learn from the Netherlands' approach to redress increasing antidepressant use. The rate of antidepressant use in Australia is among the highest in the world (one in seven adults) and increasing, while the rate in the Netherlands is about half that of Australia and remained steady over 2013-2021. The Netherlands achieved this through a multifaceted approach including improved access to non-pharmacological alternatives, initiatives targeting safer antidepressant prescribing and deprescribing, and tight regulation of pharmaceutical company influence on prescribers. Australia may learn from the Netherlands' approach to redress increasing antidepressant use.