Antidepressants being prescribed needlessly, study suggests


(CBS) Not depressed? That doesn't mean your doctor won't hand you a prescription for antidepressants.

More and more doctors are prescribing the drugs for patients who aren't suffering from depression or any other mental illness, according to a provocative new study.

"We've seen a marked increase in antidepressant use among individuals with no psychiatric diagnosis," study author Dr. Ramin Mojtabai, an associate professor at Johns Hopkins Bloomberg School of Public Health, said in a written statement. "Between 1996 and 2007, the number of visits where individuals were prescribed antidepressants with no psychiatric diagnoses increased from 59.5 percent to 72.7 percent."

The study, which involved an analysis of medical records for 230,000 patient visits, involved only non-psychiatrists - who may be less knowledgeable about just which conditions respond to antidepressants and which don't, Dr. Mojtabai told CBS News.It was published in the August 2011 issue of Health Affairs.

In addition to major depression, generalized anxiety disorder, other emotional problems, antidepressants known to be effective for certain kinds of pain and other physical complaints. But Dr. Mojtabai said there's scant evidence that antidepressants offer any relief from the vague complaints for which some non-psychiatrists prescribe them, including stress, relationship problems, low self-esteem, and ordinary ache and pains.

The biggest outrage? Some patients were prescribed antidepressants even when the medical record indicated no reason.

What explains the increasing use of antidepressants? Dr. Mojtabai blamed the direct-to-consumer drug ads, which can encourage some patients to ask their doctors for antidepressants. In addition, non-psychiatrisst may be less knowledgeable about antidepressants - what they're good for and what not.

But Dr. Victor Reus, professor of psychiatry at the University of California at San Francisco School of Medicine, told WebMD that there may be other explanations. One possibility, he said, is that doctors who get reimbursed at lower rates for treating psychiatric conditions may use a different illness code in their records. Another is that, given the continuing stigma about mental illness, doctors may be reluctant to indicate mental illness in a patient's records.

Whatever the explanation, it's clear that Inappropriate prescribing of antidepressants doesn't just waste time and money. It can expose patients to withdrawal symptoms when they go off the drugs. In addition, antidepressants are under increasing scrutiny for their side effects, which include weight gain, sexual problems, and diabetes.

What advice does Dr. Mojtabai have for patients?

He said any patient who receives a prescription for an antidepressant should ask the doctor two questions: "What is the reason you are prescribing this for me?" and "What is the evidence that this is more effective than a placebo?"

The National Institute of Mental Health has more on psychiatric medications.


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