Antidepressant Use Growing in Primary Care
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Americans are no strangers to antidepressants, according to a new study by researchers at Johns Hopkins University. During the last 20 years, the use of antidepressants has grown significantly, making them one of the most costly and the third most commonly prescribed class of medications in the United States. The growing number of prescriptions written by physicians who are not psychiatrists is one reason for the recent increase in antidepressant use. In the United States, nearly four out of every five antidepressant prescriptions are written by such providers.
According to the Centers for Disease Control and Prevention (CDC), nearly 9% of the U.S. population received at least one antidepressant during any given month between 2005 and 2008. To better understand usage patterns, the researchers reviewed a national sample of 230,000 office-based physician visits by patients at least 18 years of age during a one-week period, as recorded in the 1996-2007 National Ambulatory Medical Care Surveys. The CDC then compared office visits where patients were given prescriptions for antidepressants without a psychiatric diagnosis with those where a psychiatric diagnosis was noted in the record and with visits where patients received neither an antidepressant nor a psychiatric diagnosis. They also assessed physician practice-level trends in antidepressant visits without a psychiatric diagnosis.
Among all non-psychiatrists, the proportion of antidepressant prescriptions without a psychiatric diagnosis increased almost threefold, from 2.5% to 6.4%. The proportion increased more than twofold among primary care providers and almost threefold among other non-psychiatrist providers.
Although visits to primary care providers (PCPs) comprised less than 50% of visits to non-psychiatrists, PCPs prescribed almost three times as many antidepressants than other non-psychiatrists. The authors of the study found that the share of non-psychiatrists who prescribed antidepressants without a psychiatric diagnosis rose from 30% in 1996 to 55.4% in 2007. They also determined that between 1996 and 2007, the proportion of primary care visits where individuals were prescribed antidepressants without a psychiatric diagnoses increased by more than 200%. By contrast, prescriptions for antidepressants for patients diagnosed with major or chronic depression increased by only 44% among PCPs and 12.8% among other non-psychiatrists.
The antidepressants prescribed to patients without a diagnosed mental health condition were more likely to be provided to minorities and patients with public insurance and chronic medical conditions, such as diabetes and heart disease. The data also suggested an association between antidepressant prescriptions and conditions such as nonspecific pain, premenstrual tension, abnormal sensations, and migraine, as well as nervousness, sleep problems, sexual dysfunction, and an inability to quit smoking.
Limitations to the data include the possibility of incomplete coding data, a miscommunication between PCPs and mental health specialists, and a fear that coding for a psychiatric diagnosis will lead to stigmatization.
While the authors of the study don’t believe that the inappropriate use of antidepressants is increasing, they do advocate for additional training and clinical efforts to 1) ensure that patients receive the most appropriate treatments, and 2) increase communication between PCPs and mental health specialists.
Jill Shuman, MS, ELS
Published on August 16, 2011
- Mojtabai R, Olfson M. Proportion of antidepressants prescribed without a psychiatric diagnosis is growing. Health Aff (Millwood). 2011;30(8):1434-1442.
- Hsiao CJ, Cherry DK, Beatty PC, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2007 summary. Natl Health Stat Report. 2010;27:1-32.
- Mark TL, Levit KR, Buck JA. Datapoints: psychotropic drug prescriptions by medical specialty. Psychiatr Serv. 2009;60(9):1167.
- Ambulatory health care data. Centers for Disease Control and Prevention Website. http://www.cdc.gov/nchs/ahcd.htm Updated July 19, 2011. Accessed August 10, 2011.