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.
Source: AARP.org
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Home Care Services in West Bloomfield Township, MI
Most Patients Don’t Tell Their Doctors They Take Supplements
Did you take your multivitamin today? Toss down a fish oil supplement? Swallow a couple of chondroitin capsules to ease your aching, arthritic knees? Pop a ginkgo biloba to improve memory?
You could be doing more harm than good.
Nearly half of all older adults use herbal and dietary supplements regularly, yet most fail to share that information with their doctors, according to researchers at the Intermountain Medical Center in Salt Lake City.
Unfortunately, this oversight can lead to problems with prescription drugs, especially drugs that are highly sensitive and easily thrown off balance. These drugs have what’s called a narrow safety margin and include medications such as digoxin, lithium, phenobarbital and warfarin, among others.
Popular herbal and dietary supplements can interact with these medications and alter the way they work in the body, making the drugs either more or less effective, or increasing certain side effects.
The Utah researchers were particularly interested in the commonly used blood thinner warfarin (Coumadin). Certain supplements either intensify its effect and increase the risk of bleeding because blood does not clot well — or decrease its effectiveness enough so that a clot develops, which may cut off part of the blood supply to the brain and cause a stroke.
To find out how many people taking warfarin also used supplements, the researchers surveyed 100 men and women on their first visit to a service that monitors warfarin therapy. They asked about supplement use, whether their doctors brought up the subject and whether the patients told their doctors about supplement use without being asked.
They found that 69 of the 100 men and women surveyed used supplements. The five most popular included multivitamins; individual vitamins; glucosamine, condroitin or a combination of the two; fish oil; and coenzyme Q10. Only one-third of the group said their doctors questioned them about supplement use, yet almost all reported that they would certainly own up if asked. About half didn’t feel that supplements were drugs and a majority did not consult their doctor or pharmacist before starting on one.
“Many people think that supplements aren’t really medicine since they don’t require a prescription and they aren’t listed in the drugstore’s over-the-counter medication area,” says Harvard Medical School cardiologist Elliott Antman, M.D. “They don’t even have them on their medicine radar screen, so they don’t mention it to their doctors because they think it’s irrelevant. This is a real problem.”
Take the hypothetical example of Mrs. M, a 70-year-old woman with chronic atrial fibrillation (fast, erratic heartbeat). She’s taking warfarin to reduce the risk of a stroke and also taking several medications to control high blood pressure.
The anticoagulant team that’s caring for her is following a regimen that thins the blood just enough but not too much. If for some reason Mrs. M suddenly started taking a supplement and didn’t mention it to her doctor, several things could happen.
“The supplement could stimulate the liver to metabolize warfarin more effectively so she would end up with inappropriate low levels and risk the formation of a blood clot,” says Antman, “or conversely, the supplement could increase the anticoagulant effect of the warfarin excessively and boost bleeding risk. Neither is good.”
If team members fail to ask Mrs. M if there have been any changes in the pills or supplements she uses, they may adjust the warfarin dose without understanding what’s happening. Then, if she stops the supplement, the effect of the interaction goes away and the dose has to be adjusted again. Her warfarin levels bounce around but the team has no idea why.
Warfarin certainly isn’t the only drug that can be affected by herbal or dietary supplements. Even chamomile, Mrs. Rabbit’s cure for Peter’s upset stomach, can interact with aspirin and boost the risk of bleeding. So if your doctor doesn’t already know exactly which supplements you’re taking, come forward with the information at your next appointment.
“Those of us in the medical profession are constantly reminding ourselves to ask about this, but it’s a two-way street,” says Antman.
Source: AARP.org
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Do Antidepressants Work? – Home Care Services in Warren, MI
A leading expert talks about the latest research on these drugs
Do antidepressant medications work? The question may seem an odd one to ask these days. More than one in 10 Americans have prescriptions for antidepressants, which rake in sales of almost $10 billion in the United States alone. Yet for years, researchers have questioned whether the intensively advertised drugs are truly effective. One of the first to cast doubt was psychologist Irving Kirsch, professor emeritus at the University of Connecticut and now a professor of psychology at the University of Hull in England. Widely regarded as one of the world’s leading experts on psychiatric drugs and the placebo effect, he is the author of The Emperor’s New Drugs, as well as more than 200 research papers.
The AARP Bulletin reached Kirsch at home in England to discuss his findings and the controversy they’ve sparked.
Q. Your studies suggest that antidepressants are no more effective than sugar pills, or placebos. How can that be?
A. Placebo effect is very powerful when you’re treating depression. Placebos offer hope. And one of the chief features of depressions is a sense of hopelessness, the belief that you’re not going to get better. Anything that instills a sense of hope will at least temporarily help treat depression. Our studies show that placebos are about 80 percent effective, which is exactly how effective antidepressants are in the short-term.
Q. But aren’t the newest generation of antidepressants designed to restore normal levels of serotonin in the brain?
A. The theory behind drugs such as Prozac and Paxil, which are selective serotonin re-uptake inhibitors, or SSRIs, is that depression is linked to low levels of serotonin. But most researchers have abandoned that theory. One reason is that the newest drugs are just about as effective as older drugs that don’t affect serotonin levels. In fact, a new antidepressant recently approved in France is a selective serotonin re-uptake enhancer. It has the opposite effect of drugs like Paxil or Prozac. And yet it appears to work just as well. That tells us the serotonin theory is wrong.
Q. Published in January in the Journal of the American Medical Association, a major study also cast doubt on the effectiveness of antidepressants. Does it add anything to the debate?
A. Yes. The conclusions of that study, led by researchers from the University of Pennsylvania, are almost exactly what we found. But the JAMA study is based on a completely different set of data. The fact that it came to the same conclusion shows that the findings are robust. All in all, this new study confirms and updates our conclusions.
Q. Obviously, these findings are controversial. Many doctors who prescribe antidepressants insist that they see benefits in their patients. Are they wrong?
A. Their perception is entirely right. People do get better on antidepressants. And they get better on placebos. But doctors don’t prescribe sugar pills. They prescribe medications. And when they see patients getting better, they naturally attribute that to the drug. They can’t compare antidepressants to placebos in their practices. They have no way of knowing how much of the benefit is placebo effect and how much is a chemical effect. For that, you do research.
Home Care Services in Grosse Pointe, MI
Are You Taking Too Many Pain Meds?
An unclear diagnosis can result in being overtreated
Q: I’ve been diagnosed with stenosis or moderate to severe osteoarthritis. I have severe back pain at times, along with neck and shoulder discomfort and pain in my left knee and right ankle.
My rheumatologist has me on tramadol 50 mg (one pill three times daily as needed), naproxin 500 mg (one pill twice daily) and omeprazole 40 mg (one pill twice daily). I have been on these medications for about a year and a half.
Besides my vitamin regimen and low-dose aspirin, I take no other medications. I walk about three miles a day and ride a bicycle about five miles every day. The exercise does not seem to make my symptoms worse. I’m a 5’11″, 220 pound 60-year-old white male. Do I seem to be overmedicated?
A: First, you need to know which of the two conditions you have. If you have spinal stenosis, then an orthopedist can give you an epidural steroid injection in the affected area that could provide relief for several months. If you have osteoarthritis, you may not need all the medications you are currently taking.
Let’s consider the medications one at a time.
Unless you are being treated for Zollinger-Ellison syndrome (a rare digestive disorder), the current dosing of the omeprazole (Prilosec), a proton pump inhibitor (PPI), is twice what is recommended. Studies show that people over 50 years of age who take PPIs for a year or more increase their risk of bone fractures, as the drug inhibits the body’s absorption of calcium.
If you are taking the naproxen, a nonsteroidal anti-inflammatory drug (NSAID), in extended-release form, there’s an additional problem: It’s designed to work in a normal stomach-acid environment (a gastric pH of about 6), and the 80 mg of the PPI you’re taking is, in all likelihood, pushing your gastric pH to at least a constant 9. That’s one of the reasons your pain may not be going away. NSAIDs also can expose older people to an unacceptably high risk of gastrointestinal bleeding, which can be fatal, and the risk goes up with the dosage and duration of treatment.
The tramadol, a nonnarcotic painkiller, is a good choice for you. You might want to consult with your doctor about supplementing each dose with a 325 mg tablet of acetaminophen (Tylenol) for pain relief and gradually phasing out the naproxen. Please be aware that you cannot just stop taking the naproxen; it needs to be tapered off over several weeks.
Right now the money you spend on vitamins is wasted because, with your stomach at a pH of 9 (from the omeprazole), they’re just passing through your body unabsorbed. After your medications are properly adjusted you could start back with your vitamin regimen, along with a full-strength aspirin (325 mg, enteric-coated) and 1,200 milligrams of fish oil three times a day, which should also help with your joint and arthritis pain.
Above all, keep up all the exercise, which is the real path to great health.
Source: AARP.org
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Home Care Services in Grosse Pointe, MI
Are My Mother’s Meds Making Her Fall?
And if so, which drug — or combination — is at fault?
Q. My 81-year-old mother has been falling at home, and recently fractured her arm from a fall, which has me worried. Her doctors have been doing lots of tests, and now they’ve ordered a CT scan.
I’m concerned that the medications she’s taking could be causing the falls or at least contributing to them.
She takes Lopressor for her high blood pressure, Lasix for edema, calcium for her bones and Tylenol PM, which she gets at the drugstore, to help her sleep. Could these medications be making her unsteady?
A. Your concerns are on target. Two of the drugs that your mother is taking could well be causing her to fall. Her health care providers should have reviewed her medications before ordering the CT scan and other expensive tests.
The first concern is the use of metoprolol (Lopressor), which is in a class of drugs called beta-blockers and typically isn’t the best choice for treating cardiovascular problems in older adults. That’s because nearly half of all people 60 and older don’t produce the liver enzyme (CYP 2D6) that’s needed to properly metabolize the drug. As the drug builds up in a patient’s system, all the adverse effects commonly associated with its use are exacerbated. Chief among the problems: insomnia, dizziness,vertigo and falls.
The second concern: Tylenol PM. I’m guessing that your mother has been taking this non-prescription pain reliever and sleep aid, probably without her doctor’s knowledge, because the beta-blocker makes it difficult for her to sleep.
The problem is the PM part of the Tylenol PM. This over-the-counter product (Excedrin PM is another) combines acetaminophen withdiphenhydramine, which is an antihistamine with very strong sedative effects. Such medications are contraindicated for use in older adults.
Diphenhydramine, which many of us know by the brand name Benadryl, affects all involuntary muscle activity by depressing the central nervous system and can cause constipation, confusion, vertigo, glaucoma, falls and many other problems.
Source: AARP.org
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Home Care Services in Warren, MI
9 Types of Medication Older Adults Should Use With Caution
If you’re over 65, think twice before taking these drugs
As you grow older, you’re more likely to develop long-term health conditions that require taking multiple medications. You’re also more sensitive to many common medications, including over-the-counter (OTC) drugs.
As a result, it’s not uncommon for older adults to be overmedicated and to experience adverse reactions to the ever-lengthening list of medications they take.
Ask Questions
When taking a new medication, ask your doctor or pharmacist these important questions:
1. When and how should I use this new drug?
2. What is the purpose of the medication?
3. What should I do if I miss a dose?
4. Will the drug interact with other medications, vitamins or supplements I’m taking?
5. Is a generic or lower-cost brand name medication available?
6. What side effects, reactions or warning signs should I watch for?
To lower the chances of overmedication and dangerous drug reactions, the American Geriatrics Society Foundation for Health in Aging recommends that people age 65 and over be cautious about using the following types of drugs:
Important: If you are taking any of these medications, talk to your doctor or health care provider before stopping their use.
1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Be cautious of: long-lastingNSAIDS such as piroxicam(sold under the brand-name Feldene) and indomethacin(Indocin).
The concern: NSAIDs are used to reduce pain and inflammation, but in older adults these medications can increase the risk ofindigestion, ulcers and bleeding in the stomach or colon; they can also increaseblood pressure, affect your kidneys and make heart failure worse. If NSAIDS are needed, better choices include the shorter-acting ibuprofen (Motrin) and salsalate (Disalcid).
Because of the increased risk of bleeding, don’t use NSAIDs together with aspirin, clopidogrel (Plavix), dabigatran (Pradaxa), dipyridamole(Persantine), prasugrel (Effient), ticlopidine (Ticlid) or warfarin(Coumadin).
If you take NSAIDs regularly and have a history of ulcers, or are 75 years of age or older, you may need to protect your stomach against bleeding with a prescription medication such as misoprostol (Cytotec) or a proton pump inhibitor such as omeprazole (Prilosec).
Source: AARP.org
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Medication & Risk Factors That Lead to Falls – Macomb County, MI
Aging sometimes means reduced balance, coordination, vision, strength and agility. These factors, along with certain medications and even our home environment, can increase our risk of falling.
Ground-level falls are a major health problem for people 65 and older. An estimated 30% of people in this age group fall each year, resulting in hospitalization, permanent disability, and sometimes death. In fact, injuries related to falls are the sixth leading cause of death for seniors, and annual health care costs associated with falls are approximately $10 billion dollars. Once a person has experienced a fall, a “falls cycle” can begin in which the individual experiences an ongoing fear of falling, which can result in decreased activity, loss of strength and mobility, and an increased risk of falling.
Fall Predictors
Being aware of the common risk factors and taking precautions helps lower the overall risk. One or more of the following factors can place a person at a moderate to high risk for a fall:
- Prior fall history
- Poor, uncorrected vision
- Parkinson’s disease, untreated diabetes, and obesity
- Use of medications that can cause drowsiness, dizziness, low blood pressure and weakness
- Use of multiple medications
- Poorly fitting shoes and slippers
- A cluttered, poorly lit home with multiple levels
- Slick or wet floors, throw rugs, electrical or other cords in walk ways
What You Can Do to Reduce Your Risk of Falling
A simple test called “Get-up and Go” can additionally help predict the risk of a fall by determining one’s mobility. 2 It’s easy to perform. All you need is a straight-backed chair with armrests. Make sure the chair has a high seat. Then have the individual complete the following steps:
- Rise to a standing position from the chair, using the armrests
- Stand still momentarily
- Walk 10 feet
- Turn slowly
- Walk back to the chair
- Turn around
- Sit down
A successful test occurs if the person completes this in 20 seconds or less. Those passing this test may be considered at low risk when other risk factors are absent.
Some medications can place a person at risk for having a fall. The following are some of the most common fall-associated medications: Sleep medications, pain medications, anti-anxiety medications, anti-allergy medications, high blood pressure medications, water retention medications, anti-depressants, overactive bladder medications, and tranquilizer medications.
How can you reduce your risk of having a fall that might be caused by medication?
- Take your time. Stop for a moment before getting up. Stand slowly to be sure that you have your balance and aren’t light-headed — then walk. This allows your blood pressure to normalize and helps prevent orthostatic hypotension (also known as a head rush or a dizzy spell).
- Use the bathroom before bed. If you are taking a diuretic, schedule your last dose a few hours before going to bed. Also, leave a soft light on that illuminates your pathway to bathroom in case you need to get up during the night.
- Avoid alcoholic beverages in excess.
- Exercise regularly. Exercise strengthens important muscle groups and improves your balance and coordination. Ask your health care provider about the best type of exercise for you.
- Make your home safer. Inspect each room of your home for safety hazards such as poor lighting, obstructed walkways, throw rugs, cords and other obstacles that could cause you to trip. Place regularly used items within reach so you don’t require a ladder or stool. Install anti-slip mats and grab bars in showers and bathtubs.
- Have your vision checked regularly. Get an up-to-date prescription and treat physical conditions such as glaucoma or cataracts that can weaken your vision.
- Get checked for osteoporosis. Ask your doctor or pharmacist about the need for calcium and vitamin D.
Pure Home Care Services serves Macomb and the surrounding area. Our helpful, caring staff is ready to help you and your family. Give us a call! Our number is (586) 293-2457.
Source: AARP.org