August 4th, 2011
Antidepressants Given More Widely
The Wall Street Journal
More people without any documented psychiatric condition are taking antidepressants, according to a study being published Thursday, and some of them are likely receiving little benefit.
Nearly three-quarters of antidepressants in the U.S. were prescribed by non-psychiatrists in 2007, up from 60% a decade earlier, according to the analysis of a national sample of 233,144 doctor office visits, the latest data available. The percentage of these patients prescribed antidepressants without being diagnosed with a mental illness more than doubled in that period to 6.4% in 2007 from 2.5% in 1996.
The findings spark concern about whether these medicines are effective for the patients receiving them, since previous research has shown that antidepressants are most effective for people with severe symptoms, said Mark Olfson, a professor of clinical psychiatry at Columbia University and an author of the study being published in the journal Health Affairs.
“We’re left wondering whether the level of illness severity is rather low in these patients,” said Dr. Olfson. In those cases, antidepressants “may not offer therapeutic benefits…or the medication may not work any better than a placebo.”
Antidepressants were the second-most widely prescribed class of medicine in the U.S. in 2010, after cholesterol-lowering statins, according to IMS Health. Their use continues to grow: Some 253 million prescriptions for antidepressants were written in 2010, compared with 231 million in 2006. The generic version of Zoloft, known as sertraline, was the top antidepressant dispensed in 2010 with nearly 36 million prescriptions, and Celexa, or citalopram, was the second-most popular with 32 million prescriptions, according to IMS Health.
G. Caleb Alexander, a professor of medicine at the University of Chicago who wasn’t involved in the study, said the reasons behind the prescribing pattern weren’t clear from the data, but that Dr. Olfson’s interpretation was plausible. “I think many physicians regard these drugs as relatively safe and are willing to try them in settings where there is limited effectiveness,” said Dr. Alexander, who recently published a paper on trends in the use of antipsychotic drugs.
Physicians may be prescribing antidepressants for more mild forms of mood and anxiety disorders, or for isolated psychiatric symptoms like sleep disturbance, nervousness or nonspecific pain, he said.
Medication might not be a negative thing if patients are getting appropriate care, even from a nonspecialist, Dr. Alexander noted. “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, he said. Widespread acceptance of antidepressants in these settings have “defused the stigma” of getting treatment for mental illness, he said.