Proportion Of Antidepressants Prescribed Without A Psychiatric Diagnosis Is Growing
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.Health Affairs (Impact Factor: 4.97). 08/2011; 30(8):1434-42. DOI: 10.1377/hlthaff.2010.1024
Over the past two decades, the use of antidepressant medications has grown to the point that they are now the third most commonly prescribed class of medications in the United States. Much of this growth has been driven by a substantial increase in antidepressant prescriptions by nonpsychiatrist providers without an accompanying psychiatric diagnosis. Our analysis found that between 1996 and 2007, the proportion of visits at which antidepressants were prescribed but no psychiatric diagnoses were noted increased from 59.5 percent to 72.7 percent. These results do not clearly indicate a rise in inappropriate antidepressant use, but they highlight the need to gain a deeper understanding of the factors driving this national trend and to develop effective policy responses. To the extent that antidepressants are being prescribed for uses not supported by clinical evidence, there may be a need to improve providers' prescribing practices, revamp drug formularies, or vigorously pursue implementation of broad reforms of the health care system that will increase communication between primary care providers and mental health specialists.
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- "Whilst limited by the data available (age, sex and prescribing data) this study reported that being female, older, previously using benzodiazepines and being treated by a psychiatrist all increased the probability of long-term antidepressant use. Previous findings suggest that antidepressant use in primary care can be influenced by factors other than clinical symptoms (Mojtabai and Olfson, 2011). A multi-centre study across 14 countries found that the decision to prescribe antidepressants is influenced at least as much by socio-demographic factors as by clinical factors related to depression (Kisely et al., 2000; Nielsen and Gotzsche, 2011). "
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- "disability in more recent years (Mojtabai, 2011a). However, trends in mental health service use in general and psychological distress need to be further examined. "
ABSTRACT: There has been an increase in the use of mental health services in a number of industrialized countries over the past two decades with little impact on mental health status of the populations. Few studies, however, have examined recent trends in mental health status in the US. Using data from three large general annual population surveys in the US-the National Health Interview Survey, Behavioral Risk Factor Surveillance System, and National Survey on Drug Use and Health-we examined temporal trends in non-specific psychological distress, depressive episodes and mental health treatment seeking over the 2001-2012 period. Prevalence of past-month significant psychological distress and past-year depressive symptoms changed little over time. However, a larger percentage of participants reported poor mental health for ≥15 days or 30 days in the past month in 2011-2012 (8.7% and 5.7%, respectively) than in 2001-2002 (6.6% and 4.6%). A larger percentage of participants in the later period also reported receiving mental health treatments. Possible changes in mental health status may have been missed due to the limited scope of assessments or the small magnitude of changes. Potential reciprocal influences between service use and mental health status could not be investigated because of cross-sectional data. Despite increasing use of mental health treatments in the US in the first decade of this century, there is no evidence of decrease in prevalence of psychological distress or depression. Poor match between need for treatment and actual treatments received in usual care settings may partly explain the findings. Copyright © 2014 Elsevier B.V. All rights reserved.