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.
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