More Doctors Prescribing Antidepressants

A new study last week found that prescriptions for antidepressants for patients without a psychiatric diagnosis increased from 2.5 percent of all visits to nonpsychiatrists to 6.4 percent between 1996 and 2007. For visits to primary care providers, antidepressant prescriptions without a psychiatric diagnosis grew from 3.1 percent of all visits to 7.1 percent over this period; for other nonpsychiatric providers, the increase was from 1.9 percent of visits to 5.8 percent.

The study also reported that patients who received antidepressants from nonpsychiatrists without a psychiatric diagnosis were:

  • most likely to be fifty years old or more,
  • less likely to be paying for the visit out-of-pocket, and
  • more like to suffer from another medical condition like diabetes and to have excessive fatigue or non-specific pain.   

So what does this mean?  I suspect the take home message is that non-psychiatrists (primary care physicians and other non-psychiatrist prescribers) are so comfortable with the newer antidepressants (which have fewer side effects) that they often use these medications to alleviate overall discomfort and vague symptoms in their patients.  But I also think we have responsibility here.  I suspect this increase also reflects our broader wish to “take a pill” to fix things—as opposed to looking at the underlying causes of our problem, or to engage in longer term types of “talk” therapy treatments to address longer term issues, or other factors that give rise to illness in our lives. 

Usually the most effective treatment for depression, anxiety and most mental health issues is a combination of medication and psychotherapy.  Similarly, if you have a heart ailment, along with medications, you will need to make changes in your diet, stress levels, and other areas of your life.  With most diseases—getting well often involves major lifestyle changes across many aspects of your life.   It is these less-tangible, more difficult changes that often interfere with our recovery from any disease.

So, how can we get this message out to the public more effectively?   We need to shift our emphasis from mental illness to mental health and shift away from the notion that a “pill” will give us that quick cure to the notion that treatment of all diseases requires lifestyle changes.  We also need to remove the “stigma” associated with talking cures.

One by one—start talking about prevention and start talking about wellness in your conversations with friends.  Get a mental health check-up and encourage others to do the same.  At the heart of the effort to transform the mental health system is the need for a change in everyone’s thinking – from believing that depression or anxiety represent some sort of moral weakness, to an understanding that recovery from a mental illness happens all the time, if you get help in the form of good treatment, just like any other disease.   Rarely does that treatment come in the form of one simple “pill.”