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Antidepressants Prescribed Without Psychiatric Diagnosis

Study Documents Rise in Use of Antidepressants From Non-Psychiatric Illnesses
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WebMD Health News
Reviewed by Laura J. Martin, MD

Aug 4, 2011 -- Antidepressants may be increasingly prescribed by non-psychiatrists to treat medical disorders in the absence of a psychiatric diagnosis.

The proportion of non-psychiatrist doctor visits where antidepressants were prescribed without a documented psychiatric diagnosis increased from 59.5% to 72.7% between 1996 and 2007, according to a new study in Health Affairs.

Experts not affiliated with the study are quick to caution that there are many possible, and plausible, explanations for what seems to be an uptick, and that depression remains largely underdiagnosed and undertreated in the U.S.

In the study, researchers analyzed antidepressant prescriptions written for adults aged 18 and older from 1996 to 2007 during office-based doctors’ visits. In 1996, 2.5% of all visits to non-psychiatrists resulted in an antidepressant prescription. In 2007, that increased to 6.4%. Antidepressant prescriptions from primary care doctors for nonpsychiatric disorders increased from 3.1% to 7.1% during the study period. Many of these patients were listed as having general medical conditions such as diabetes, heart disease, or nonspecific pain symptoms.

Are Non-Psychiatrists Doling Out Antidepressants?

By contrast, antidepressants prescribed by non-psychiatrist doctors for psychiatric diagnoses only increased from 1.7% to 2.4% from 1996 to 2007, the study showed.

“We need to better understand the causes for increased prescription of antidepressants without a psychiatric diagnosis in the general medical settings,” study author Ramin Mojtabai, MD, PhD, MPH, an associate professor in department of mental health at Johns Hopkins Bloomberg School of Public Health in Baltimore, says in an email.

“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,” he says.

Although the findings suggest that these medications may be overly prescribed, depression and anxiety disorders are still underdiagnosed and undertreated, he says. “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,” Mojtabai says.

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