Why are we experiencing a rise in medication dispensing to young adults in New Zealand?

Of the roughly 800 million people worldwide with a mental disorder, depression and anxiety are the most frequent, and both have a significant burden of disability. The prescription of psychotropic medication used to treat psychiatric disorders, such as antidepressants, antipsychotics, and stimulants, has increased worldwide over the past two decades. This increase has also been evident in the children and adolescent prescriptions internationally as well as locally. 

According to a report on the state of New Zealand’s public mental health sector, antidepressant medications dispensed to children and teenagers increased 53% in the past five years, If antidepressants are prescribed to young people, they should ideally be used in conjunction with evidence-based talk therapies such as cognitive behavioural therapy and should be closely monitored. However, the pressures on mental health services mean that in reality, many patients struggle to get psychological therapy.

The prevalence of mental health problems in New Zealand are increasing. The New Zealand Health Survey reported an increase of emotional and/or behavioural problems for 2–14-year olds from 1.8% in 2006/2007 to 4.3% in 2015/2016. The increase of prescriptions may therefore seem reasonable. However, as reported in literature, there is no evidence that increased prescribing has been associated with a decrease in the burden of mental illness. If anything it has been associated with an increase. A new Cochrane review, found that on average, antidepressants led to only small improvements in depression symptoms compared with placebo in children and adolescents (ranging in age from six to 18 years old).

There are a range of ways in which young people can and need to be supported. There is good evidence for regular physical activity, good nutrition, and adequate sleep. Support from family, schools and the broader community is also important. A decision to use medications should be on the basis of shared decision-making. This refers to conversations where the risks and benefits of all treatment options are described to the young person, and their family, who are then meaningfully involved in making the decision.

The rapid rise in mental health concerns among young people in NZ over the last decade cannot be ignored any longer. There is an urgent need to identify youth specific risk and protective factors to inform effective prevention strategies that can be implemented from early childhood. A greater emphasis on mental wellbeing promotion will require collaboration with young persons to co-design youth specific and culturally responsive solutions for better mental health outcomes. Such targeted efforts will promote greater wellbeing and brighter futures for our increasingly vulnerable youth population.