Blog | Thursday, August 4, 2011

QD: News Every Day--Rise in antidepressants brought into question

Prescriptions for antidepressants given by nonpsychiatrists to patients without a specific psychiatric disorder increased more than 12% in 12 years, leading to the drug class becoming the third most commonly prescribed, a study found.

A study in the August issue of Health Affairs reported that antidepressant prescriptions by doctors who didn't record a specific psychiatric disorder increased from 59.5% of all prescriptions by nonpsychiatrists in 1996 to 72.7% in 2007.

Researchers reviewed data on patients age eighteen or older from the 1996-2007 Centers for Disease Control and Prevention's National Ambulatory Medical Care Surveys, a national sample of more than 233,000 office-based visits. The proportion of antidepressants prescribed for patients without a psychiatric diagnosis increased from 2.5% of all visits to nonpsychiatrist providers to 6.4% between 1996 and 2007. For visits to primary care providers, antidepressant prescribing grew from 3.1% to 7.1%. For other nonpsychiatric providers, visits without a psychiatric diagnosis grew from 1.9% to 5.8%. In contrast, antidepressants prescribed with a psychiatric diagnosis increased from 1.7% to 2.4%.

Patients who received antidepressants without a psychiatric diagnosis by nonpsychiatrist providers were more likely to be 50 or older, and less likely to be males, members of a racial or ethnic minority, new patients, or to be paying for the visit themselves, researchers noted. These patients also tended to suffer from diabetes, heart disease, or multiple medical conditions; have excessive fatigue and headaches; or complain of nonspecific pain or abnormal sensations.

Researchers said the growing use of antidepressants for broader conditions, such as boosting moods, relieving mild anxiety, or improving sleep, raises worrisome questions about whether the drugs are being inappropriately prescribed.

The lead author noted, "Many of the patients who are receiving these medications are dealing with the stresses of life or physical illness, and there is no evidence that antidepressants are effective in these groups of patients."

The study recommended:
--Taking steps to better educate physicians on how to recognize mental disorders and what the evidence shows about the long-term benefits and limits of antidepressants.
--Reforming insurers' drug formularies to help rein in inappropriate antidepressant prescribing.
--Reducing fragmented care to improve the delivery of mental health services and foster better collaboration among providers.

"Prescribing antidepressants without a psychiatric diagnosis is especially common in medical practices that prescribe the medications to a larger percentage of their patients," the authors concluded. "Yet paradoxically, a large proportion of patients with common mental disorders do not receive needed treatment because their primary care providers do not detect their conditions."

The study also suggested that patients discuss with their physicians whether antidepressants are the right treatment, and for physicians to seek alternative treatments.