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Antidepressants Prescribed Without Psychiatric Diagnosis

Study Documents Rise in Use of Antidepressants From Non-Psychiatric Illnesses

Are Non-Psychiatrists Doling Out Antidepressants? continued...

The solution, he says, involves both clinician and patient education regarding the appropriate treatment with antidepressants.

Mojtabai’s co-author, Mark Olfson, MD, a professor of clinical psychiatry at the College of Physicians and Surgeons of Columbia University and a research psychiatrist at New York State Psychiatric Institute, both in New York City, says that the new findings “raise concerns about inappropriate use of antidepressants.”

But the data only provide a snapshot, he says. “It is possible that these individuals have a history of depression or other mental health issues that led to the prescription but may not be documented in this visit,” he says.

The findings may also speak to our fragmented health care system, Olfson says. “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,” he says. “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.”

Peter D. Kramer, MD, a psychiatrist at Brown University in Providence, R.I., and the author of several books, including Listening to Prozac, says that the study asks more questions than it answers.

“This is a chart review so the question is, ‘Are the findings documenting inappropriate prescribing or inappropriate charting?’” he says.

“Most people are treated outside of specialty, and there have been very extensive efforts to educate the primary care community about depression, and it's hard to say whether this study shows the success of this effort or the failure,” he says.

Many Explanations

Victor Reus, MD, professor of psychiatry at the University of California at San Francisco School of Medicine, says that there may be more going on here than meets the eye. For example, doctors often get reimbursed at lower rates for treating psychiatric conditions, so they may be more likely to use another code in the files. There are also still stigmas attached to psychiatric illnesses, which could play a role in the lack of diagnoses evident in some of these records.

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