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Huge Rise in Antidepressant Prescribing to People without a Diagnosis of Depression

Researchers at John Hopkins University say that primary care physicians are more likely than ever to prescribe antidepressants and in a significant percentage of cases, to prescribe these medications without making a diagnosis of mental illness.

The researchers used survey data from the CDC to look at how often and for what reasons general practitioners are prescribing antidepressant medications. They examined the medical records of  233,144 adults who had seen a doctor in an office setting from 1996 to 2007. They found that:

  • Over the 12 year study period, 9.3% of visits to a primary care physician (not a psychiatrist) led to a prescription for an antidepressant.
  • In 1996, 2.5% of visitors to a primary care physician left without a diagnosis of a mental illness but with a prescription for antidepressants – by 2007, that percentage had jumped to 6.4%
  • Primary care doctors prescribed nearly three quarters of all antidepressants in 2007. This is a 60% increase from a decade prior.

Why has there been such a marked increase in antidepressant prescribing over the last decade or so? Study leader Dr. Ramin Mojtabai says pharmaceutical company advertisements which target consumers directly and get people asking their doctors for these medications are a likely cause for at least some of the spike in prescriptions written.

Experts also speculate that as safety has improved and acute side effects have diminished doctors have been more willing to prescribe these medications for conditions like sleep disturbances, non specific pain, stress or low self esteem – as G. Caleb Alexander, a professor at the University of Chicago Medical School explains, "I think many physicians regard these drugs as relatively safe and are willing to try them in settings where there is limited effectiveness.”

Although general practice doctors prescribing anti depressant drugs to patients without mental illness may sound irresponsible, Dr. Alexander explains that "It's terribly important to recognize that primary-care physicians treat a large fraction of people with mental illness, including some who otherwise wouldn't seek help from a psychiatrist.”

Other experts, like Dr. William Narrow of the American Psychiatric Association (APA) say it’s important to remember that despite the huge numbers of people being prescribed these medications, the fact remains that “The majority of the people who have mental disorders still do not get treatment. We have a large group of people out there who are not getting help."

Dr. Narrow says the APA is working on a series of prescribing guidelines for primary care doctors so that they can better diagnose and prescribe for people with mental illness. In many cases, he says, people leaving doctors’ offices with prescriptions for antidepressants to treat minor depressive symptoms would be more effectively treated with psychotherapy.


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