Nature Medicine | Spoonful of Medicine

More patients without a psychiatric diagnosis receiving antidepressants

antidepressans84.jpgAntidepressants are the third most common drug taken in the US and the prescription rate nearly doubled between 1996 and 2005. An analysis published today in Health Affairs suggests that the same timeframe saw a leap in the number of patients receiving these types of drugs without a psychiatric diagnosis.

The researchers analyzed survey data from the US Centers for Disease Control and Prevention on patient visits to non-psychiatrists between 1996 and 2007. The scan of more than 230,000 visits to non-psychiatrists found an increase of antidepressant prescriptions overall, from 4% to nearly 9% of patients. Of those patients that received antidepressants, 72% received no recorded psychiatric diagnosis in 2007, up from 59% in 1996.

“The question is: what does that mean and why, as it’s hard to say exactly what the underlying causes of this trend are,” says psychiatrist Mark Olfson of Columbia University in New York, who was an author on the new study. “It’s possible that primary care physicians are having less contact with psychologists and counselors, or that they’re writing these prescriptions but don’t really know what they’re being used for.”

There are several approved non-psychiatric diagnoses for antidepressants, including diabetic neuropathy and migraine headache. And as we reported earlier this year, they are being tested for everything from hot flashes to stroke Notably, a 2009 study found that non-psychiatrists write nearly four out of every five of antidepressant prescriptions in the US, possibly for ‘off-label’ use.

Olfson and his colleagues found that many of the people who received the drugs had persistent medical conditions, such as diabetes or heart disease. In cases where there was no psychiatric diagnosis at all, it’s possible that those patients simply “say they’re not feeling well, or maybe they’re having less serious problems adjusting to changes in their lives,” Olfson speculates. However, these off-label uses have not been proven to help these conditions, and they may not even assist those patients with less severe depression.

There are some caveats to the study. The researchers analyzed all visits in isolation, so it’s possible that some patients had previously received a psychiatric diagnosis and the non-psychiatrist was simply continuing the drugs. Additionally, unless noted in the survey, it’s unknown why exactly the drugs were prescribed. The researchers hope to dive into the data and zoom in on individual cases to see “how many of them are just being prescribed without a clear indication,” says Olfson.

Image: by Amanda Hatfield on Flickr under Creative Commons

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