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Antidepressant Use On the Rise For Milder Conditions

Antidepressant Use On the Rise For Milder Conditions

 

Antidepressants have become the third-most commonly prescribed medications in the US. The drugs are now routinely prescribed for people with “vague complaints of fatigue, pain and malaise,” says the Los Angeles Times. A new study in Health Affairs supports this: More and more people without a psychiatric diagnosis are now taking antidepressants and nearly four our of five prescriptions for anti-depressant medications are written by non-psychiatrists.

Ramin Mojtabai, MD, PhD, MPH, the lead author of the study and an associate professor with the Bloomberg School’s Department of Mental Health at Johns Hopkins University, indeed says in Science Daily that there has been a “marked increase” in antidepressant use by people without a psychiatric diagnosis. Specifically, between 1996 and 2007, physicians’ visits where individuals with no psychiatric diagnoses were prescribed antidepressants increased from 59.5 percent to 72.7 percent. Providers prescribing antidepressants for those without a concurrent psychiatric diagnosis went up from 30 percent of all non-psychiatrist physicians in 1996 to 55.4 percent in 2007.

Researchers used data from the 1996-2007 National Ambulatory Medical Care Surveys.

Mojtabai and colleagues also found that, in general medicine practice, antidepressant use was concentrated among people with less severe and poorly defined mental health condition, based on an assessment of “physician practice-level trends in antidepressant visits without psychiatric diagnosis.” But an earlier study by Mojitabai in the Journal of Affective Disorders found that antidepressant use significantly lessened “prevalence of more severe depression and suicidal ideations among individuals with severe depressive episodes,” in those with more severe psychiatric diagnoses. It’s a finding that suggests that such medications are most useful for those with severe depression or a confirmed psychiatric diagnosis and have little and limited effect on milder conditions.

The increased prescription of antidepressants among those without such diagnoses, and for “off label” use, also points to a need to re-examine prescription policies, especially as more non-specialists use them for purposes that have not been borne out by clinical evidence. Specifically, Mojitabai says there is “a need to improve providers’ prescribing practices, revamp drug formularies or undertake broad reforms of the health care system that will increase communication between primary care providers and mental health specialists.”

The Los Angeles Times notes that, while physicians sometimes do not give a psychiatric diagnosis to a patient because of the perception that it is stigmatizing, such concerns are not enough to explain the trend that Mojitabai and his colleagues note. Dr. Jeffery Huffman, a consulting psychiatrist at Massachusetts General Hospital, says that “primary care physicians are often best positioned to recognize changes in a longtime patient’s mood that might suggest disabling depression or anxiety,” but emphasizes that there is still a need for accurate evaluation for a psychiatric condition, not to mention treatment and follow-up.

Currently, there is a lack of coordination between primary care physicians and medical specialists, says Huffman. But provisions in the new federal health care law could lead to more “collaborative care” practices in which mental health care and medical treatment of patients with chronic diseases and complex health issues are integrated.

Americans now spend $10 billion annually on antidepressants; at least some percentage of those dollars might be otherwise spent on things other than little blue pills.

Related Care2 Coverage

Therapy Via the Web: What Would Freud Think?

3 Harvard Psychiatrists Disciplined Over Drug Company Ties

Ask For Updates, Write Prescriptions, Ask to See Next Patient: Is This Psychiatry Today?

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Photo by Amanda M Hatfield

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41 comments

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1:42PM PDT on Oct 16, 2011

Thanks for the article. Sad.

6:50AM PDT on Aug 16, 2011

thanks for this

5:36PM PDT on Aug 14, 2011

Thanks for the article.

12:09PM PDT on Aug 14, 2011

A psychiatric nurse onece told me that the best piece of psychiatric advice ever given was, "For God's sake pull yourself together!". Learn to live with yourself instead of trying to drug yourself into being something that you're not. There are many ways of improving your life and wellbeing and NONE of them involve swallowing these little doses of poison every day!

1:41AM PDT on Aug 14, 2011

Interesting! Thank you

2:04AM PDT on Aug 12, 2011

Well said, Deborah!

2:04AM PDT on Aug 12, 2011

very sad

1:29AM PDT on Aug 12, 2011

Interesting article

8:42AM PDT on Aug 11, 2011

America had been an "instant" culture, where life problems are thought to be solvable with a pill instantly, rather then contemplating life and solving problems rather then symptoms (i.e. depression or any other misery). Additionally, those advertisements on TV regarding how various antidepressants will lift your mood instantly work, as any propaganda does on people who are not in a custom of critical thinking. People are not accustomed to think that sometimes it is good to be depressed and sit down and re-evaluate one's life.

8:27PM PDT on Aug 9, 2011

Is it any wonder that more people are on Prozac than ever before? Would it have to do with the climate in the US? The Recession? No Jobs? Everyone losing their savings because Congress hasn't grown up and realized that they are there to do a job that we told them we want done, not to play with their toys and cry fowl when it doesn't go their way? I can't imagine why anyone would want drugs.

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