Are Doctors Overprescribing Antidepressants?
Many people not diagnosed with depression take them
More doctors who are not psychiatrists are offering antidepressants to patients, often for vague complaints of fatigue, headaches or gloominess.
Indeed, the practice of prescribing these drugs without a diagnosis of depression is escalating and more common in men and women over age 50.
Nearly four of every five prescriptions are written by primary care doctors and specialists untrained in psychiatry who are dispensing powerful drugs that may have either no impact or harmful effects.
Antidepressants are now the third most commonly prescribed class of drugs in the United States, according to a study in the August issue of Health Affairs. (Prescription painkillers and cholesterol-lowering drugs were the first and second most prescribed drugs, the study reports.) Antidepressants also are one of the most costly medications to the health care system, with annual sales of approximately $11 billion.
The drugs are effective for a limited number of conditions, including clinical depression, chronic depression and some anxiety disorders.
“My sense is that we now have a large group of people taking them for unclear reasons,” says coauthor Mark Olfson, M.D., a professor of clinical psychiatry at Columbia University. “And when you treat less severe problems, it becomes harder to demonstrate that they’re helpful at all.”
The study looked at information from surveys conducted by the Centers for Disease Control and Prevention that considered more than 230,000 visits by adults to offices of primary care doctors and specialists who were not psychiatrists.
Researchers found that 73 percent of prescriptions for antidepressants were written for patients with no formal diagnosis of depression in 2007, compared with 60 percent in 1996.
The share of doctors who prescribed antidepressants without such a diagnosis increased from 30 percent to 55 percent in the same period. The typical patient who received antidepressants without a formal diagnosis was a white woman over 50 who had high blood pressure, diabetes or several medical problems.
Psychiatrist Dilip Jeste, M.D., of the University of California in San Diego calls the study’s conclusions important.
Jeste, president-elect of the American Psychiatric Association, says that recommending medications for reasons not approved by the Food and Drug Administration, a practice called off-label prescribing, “is not illegal, nor is it rare in clinical practice.” However, “antidepressants are powerful drugs and can have a variety of adverse effects, which are more common in older adults with multiple medical problems,” so “the study’s findings are worrisome.”
Depending on the specific drug, side effects can include dizziness, sleep problems, changes in blood pressure and weight gain.
Olfson says that people should recognize the difference between the sadness and grief that becomes more common with age and the persistent and distressing pattern of depression that interferes with sleep, appetite and concentration. He advises people to talk over these feelings with a doctor.
“Find out if your doctor feels your symptoms fit the definition of clinical depression, and why, and whether medication will help,” Olfson says. “And because antidepressants don’t work immediately, ask how long it will take before you can expect to see a difference.”
You should be able to take time to talk about these matters with your doctor and not try to rush through the conversation in the course of one hurried 15-minute visit.
“This discussion will help you understand your own treatment better so you can recognize if it is or is not working,” counsels Jeste.
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