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Antidepressant Use With No Psychiatric Diagnosis Raises Public Health Concerns
Depression is a major public health problem that cannot always be seen, but its effects reverberate throughout society. Depressive episodes cause billions in extra health care costs each year, and can indirectly cause other serious health problems.
Because depression is so common, it is no surprise that antidepressant use is extremely popular with Americans – in both adults and children. In the last two decades, we have seen a spike in the prescription of various antidepressants. The CDC reported recently that almost nine percent of the American population had at least one antidepressant prescribed from 2005-2008. Antidepressants are the third most frequently prescribed type of drugs prescribed in the country.
Yet, these powerful drugs often are distributed without any psychiatric diagnosis at all. This fact presents some serious public health questions – on top of the overall public health problem of depression:
- How effectively is the American health system is treating people with serious depressive episodes, if many of those being prescribed are not being evaluated by psychiatrists?
- What potential solutions can we identify to better screen and treat people with serious problems with depression?
80% of Prescriptions Written by Non-Psychiatrists
The evidence is striking. According to a study at the Johns Hopkins Bloomberg School of Public Health, almost four out of five prescriptions for antidepressants were written by medical professionals who do not practice psychiatry. The study found that from 1996-2007, the number of doctor visits where a person was given antidepressants with no psychiatric treatment or diagnosis increased from 59% to 73%.
Researchers also have analyzed data from the National Ambulatory Medical Care Surveys from 1996-2007. They found that the prescription of antidepressants often is concentrated in patients with relatively mild mental health issues. Still, under recognition of serious depressive disorders is commonplace, even though these conditions account for as many as 10% of patients seen by primary care professionals.
Another study published in The Journal of Affective Disorders found that the use of antidepressants seriously reduced severe depressive episodes and suicidal tendencies in those patients diagnosed by a psychiatrist with severe depression.
As non-specialists are playing such an important role in the prescription of antidepressants today, it seems clear that this fact needs to be more effectively integrated nto the public health system in the US.
What Should Be Done?
As we have seen, antidepressant prescriptions are often being given without any clinical evidence supporting their distribution. This suggests there may be a need to improve the prescribing practices of medical professionals who do not practice psychiatry. Also, there may be a need for a reform of our health care system so that there is better communication between the primary care doctor and psychiatrists. Programs that strive to improve follow up with patients and to better coordinate primary care and the services of psychiatrists could potentially reduce the public health problem of depression.
So, we can see the problem with the prescription of antidepressants, but what is the solution? Would the above ideas help to prevent the more severe forms of depression and improve public health? What do you think?
Joseph Pickett is a staff writer for MPHprogramslist.com, a public health education portal where he writes about science and the art of improving the health of local communities through education, promotion of healthy lifestyles with the end goal of preventing disease & prolonging life.