Antidepressants Often Prescribed For Non-Psychiatric Illnesses

Antidepressant use is on the rise, in part because nonpsychiatrists are prescribing these drugs without a psychiatric diagnosis. In many cases, such practitioners are prescribing antidepressants to patients not necessarily complaining of depression symptoms.

As a matter-of-fact, nonpsychiatrist doctor visits in which antidepressants were prescribed with no psychiatric diagnosis rose from 59.5 percent to 72.7 percent from 1996 to 2007, said Web MD, citing a study in Health Affairs. Some experts maintain that depression is both undertreated and diagnosed in the United States.

The researchers looked at prescription practices for adults aged 18 years and older during the research period (1996-2007) in physician office visits, said Web MD. In 1996, 2.5 percent of nonpsychiatrist visits involved an antidepressant prescription, while in 2007, that figure rose to 6.4 percent. Meanwhile, prescriptions for these drugs from primary care doctors for nonpsychiatric issues rose from 3.1 to 7.1 percent for patients who presented with conditions including diabetes, cardiac disease, and nonspecific pain, noted Web MD; antidepressants prescribed for psychiatric disorders by nonpsychiatrists rose from 1.7 to 2.4 percent.

“We need to better understand the causes for increased prescription of antidepressants without a psychiatric diagnosis in the general medical settings,” wrote study author Ramin Mojtabai, MD, PhD, MPH, in an email to Web MD. Dr. Mojtabai is an associate professor in department of mental health at Johns Hopkins Bloomberg School of Public Health in Baltimore. “What we are observing is that Americans are increasingly viewing psychiatric medications as a solution for a wide range of social and interpersonal problems and for dealing with daily stress [and] general medical providers appear to be going along with this trend,” Dr. Mojtabai added.

While Dr. Mojtabai points out that depression is largely not understood, he notes that, “The irony is that many patients with major depression or anxiety disorders who could potentially benefit from treatment with antidepressant medications do not receive these treatments,” said Web MD.

Co-author, Mark Olfson, MD, professor of clinical psychiatry at the College of Physicians and Surgeons of Columbia University who is also a research psychiatrist at New York State Psychiatric Institute, said the study findings “raise concerns about inappropriate use of antidepressants,” according to Web MD. Part of the problem, said Dr. Olfson, has to do with coordination. “If you are in a situation where you receive medicine from one doctor and see another doctor for counseling, make sure the two are communicating…. The more coordinated the care, the more focused and effective the treatment will be. Medications and counseling are more powerful together than either one alone,” Dr. Olfson added.

While antidepressants might be the appropriate drug of choice in many situations, it’s important to remember these are potent medications that are not without side effects. For instance, <"">selective serotonin reuptake inhibitor (SSRI) antidepressants have been linked to increased risks for Autism Spectrum Disorders (ASDs) and even breast and ovarian cancers. Since 2005, information has been emerging that certain SSRI antidepressants may also cause birth defects, including cardiac, pulmonary, neural-tube defects, craniosynostosis (abnormally shaped skull), infant omphalocele (abdominal wall defects), club foot, and anal atresia (complete or partial closure of the anus). Interestingly, a recent study revealed that SSRIs such as Prozac (fluoxetine) and Effexor (venlafaxine), might not be the most effective or safest choices when treating seniors for depression

Also, some older generation antidepressants are not without their risks, such as for increased likelihoods of cardiovascular disease (CVD) and interference with breast cancer treatments, causing patients to relapse and die.

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