The public health impact of antidepressants: an instrumental variable analysis.

Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
Journal of Affective Disorders (Impact Factor: 3.76). 06/2011; 134(1-3):188-97. DOI: 10.1016/j.jad.2011.05.037
Source: PubMed

ABSTRACT There has been a marked increase in antidepressant medication prescription and use over the past three decades with unclear effects on the mental health status of the population. This study examined the impact of expansion of antidepressant use on prevalence and characteristics of depression and suicidal ideations in the community.
Instrumental variable models were used to assess the impact of antidepressant treatments on the prevalence of depressive episodes, mixed anxiety and depression states and suicidal ideations in 22,845 participants of the 1993, 2000 and 2007 National surveys of psychiatric morbidity of Great Britain who were between 16 and 64 years of age.
Increased prevalence of antidepressant treatment did not impact the prevalence of depressive episodes or mixed anxiety and depression states. However, antidepressant treatment was associated with decreased prevalence of severe and, to a lesser extent, mild depressive episodes and suicidal ideations and a corresponding increase in prevalence of moderate depressive episodes.
The data were cross-sectional and based on self-report of symptoms in the past month and current medication use with no information on dose and duration of medication treatment.
Expansion of antidepressant treatments in recent years has not changed the community prevalence of depression overall, but it has reduced the prevalence of more severe depression and suicidal ideations. The findings call for better targeting and more judicious use of antidepressants in cases of more severe depressive episodes which are more likely to respond to such treatments.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Question When some of my patients who are taking antidepressants learn they are pregnant, they become anxious and confront me with the following statement: "I need this medication, but have heard so many conflicting stories from my friends and on the Internet and in the media that I am not sure if I should continue taking it." How do I advise them, as I have also seen conflicting evidence in the scientific literature? Answer To date, antidepressants are the most studied drugs during pregnancy, with more than 30 000 outcomes examining increased risks of adverse effects on exposed infants. The results of the studies can appear to be conflicting owing to differing interpretation of statistical analysis and subsequent knowledge transfer and translation of the information. However, there does not appear to be a clinically significant increased risk of any of the adverse outcomes reported in peer-reviewed published studies that would preclude a woman from taking a needed antidepressant during pregnancy.
    Canadian family physician Medecin de famille canadien 09/2013; 59(9):941-4. · 1.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess the trend in long-term use of antidepressants by persons aged ≥ 18 years, and the correlates of such use, in the United States from 1999 to 2010. We examined trends in duration of antidepressant use and correlates of long-term use in data from 6 waves of the cross-sectional National Health and Nutrition Examination Survey (N = 35,379), a representative survey of the general population. The overall prevalence of antidepressant use increased from 6.5% in 1999-2000 to 10.4% in 2009-2010 (odds ratio [OR] = 1.54; 95% CI, 1.31-1.81; P < .001). This included an increase from 3.0% to 6.9% in long-term use (≥ 24 months; OR = 2.12; 95% CI, 1.75-2.57; P < .001). Medium-term (6 to < 24 months; from 1.3% to 1.6%) and short-term use (< 6 months; from 2.2% to 1.8%) of antidepressants did not change appreciably in this period. The increasing trend in long-term antidepressant use was limited to adults who received their care from general medical providers (adjusted OR = 3.86; 95% CI, 2.57-5.80; P < .001). From 1999 to 2010, there was a marked increase in long-term use of antidepressant medications in the United States, explaining the overall increasing trend in antidepressant use. This trend calls for greater vigilance in prescribing antidepressants for long periods of time.
    The Journal of Clinical Psychiatry 12/2013; · 5.81 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study explores the spatiotemporal variations of suicide across Australia from 1986 to 2005, discusses the reasons for dynamic changes, and considers future suicide research and prevention strategies.
    BMJ Open 07/2014; 4(7):e005311. · 2.06 Impact Factor