More patients are being prescribed antidepressants by non-psychiatrists and without a psychiatric diagnosisAntidepressants now account for the third most commonly prescribed class of medication in the United States. Fueling this growth are non-psychiatrist providers who prescribe them without a psychiatric diagnosis. A new study found that the proportion of patient visits to these physicians where antidepressants were prescribed without a psychiatric diagnosis grew from 59.5 percent in 1996 to 72.7 percent in 2007.
Of all the visits to non-psychiatrist physicians, 45.8 percent were to primary care physicians. Antidepressants were prescribed in 9.3 percent of primary care visits and 3.6 percent of visits to other non-psychiatrist physicians. During the study period, there was a significant increase in antidepressant visits without a psychiatric diagnosis. The proportion of antidepressant visits without a psychiatric diagnosis grew from 2.5 percent of all visits to non-psychiatrist providers to 6.4 percent. The increase was 3.1 percent to 7.1 percent for primary care providers. Patients prescribed an antidepressant for a non-psychiatric disorder were more likely to be age 50 or older, have diabetes or heart disease, have two or more medical conditions, and have nonspecific pain or abnormal sensations.
To the extent that antidepressants are being prescribed for uses not supported by clinical evidence indicates several needs, suggest the authors. For example, there may be a need to improve providers' prescribing practices, revamp drug formularies, or pursue broad reforms of the health care system that will boost communication between primary care providers and mental health specialists.
The findings were based on analysis of data from the National Ambulatory Medical Care Surveys on patients' social, demographic, and clinical characteristics, as well as details on reasons for the medical visits and medications prescribed at each visit. The study was funded in part by a grant from the Agency for Healthcare Research and Quality (HS16097) to Rutger University's Center for Research and Education on Mental Health Therapeutics, part of AHRQ's Center for Education and Research on Therapeutics (CERT) program. For more information on the CERTs program, visit http://www.certs.hhs.gov.
See "Proportion of antidepressants prescribed without a psychiatric diagnosis is growing," by Ramin Mojtabai, M.D., Ph.D., and Mark Olfson, M.D., in the August 2011 Health Affairs 30(8), pp. 1434-1442.