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Antidepressants Overprescribed in Primary Care

Antidepressants have long enjoyed a reputation as being a quick and “easy” treatment for all types of depression — from a mild feeling of being a little down, all the way up to severe, life-debilitating depression.

But like all medications, they have side effects and instances where they should not be prescribed. Hence their continued need for a prescription after seeing a doctor.

So what does it mean when primary care physicians are handing them out like candy?

It suggests that your family doctor doesn’t really understand how antidepressants work, or what they are approved to treat. In short, it suggests that antidepressant medications are being over-prescribed by well-meaning doctors who are simply not using very good judgment.

10 Comments to
Antidepressants Overprescribed in Primary Care

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  1. Thanks for this post Doc. I have shouted this to everybody who would bear listening to me. The question is what can we do about it. I know hundreds of people that hang out in places like “Paxil Progress” and “marriages destroyed by SSRI/SNRI’s” who would do whatever it takes to change the way these drugs are handled. I have reported my story to the FDA, and the GP to the state board. You can’t sue. What do you tell a judge, “shortly after taking a drug I can’t prove she is or was on because her medical records are private, she went from a loving caring spouse of 12 years to a tyrant, then decided to divorce and go live with her alcoholic and abusive father and heavily medicated mother? She now says she is ‘happy’ and moving on. The users are in equal disadvantage.

    I am unsure why the mental health industry hasn’t stepped in and claimed these drugs as their own. That would at least help some. My ex is gone, my daughter is now a common statistic. Too much has passed to rectify that. But I would do anything to see that nobody ever had to wake up one day either somebody they are not or next to somebody they would have never married, let alone had a child with.

  2. The problem is not that antidepressants are over-prescribed — the problem is that they’re being prescribed at all.

    Marcia Angell, former editor of the New England Journal of Medicine, recently summarized the problems with antidepressant drugs. She wrote an excellent, two-part article for the New York Review of Books. Part 1 is called, “The Epidemic of Mental Illness: Why?“. Part 2 is called, “The Illusions of Psychiatry“.

    Briefly, Angell argues (and I agree) that not only are antidepressants ineffective at treating depression, but they also cause long-term harm to the patients to take them.

    Of the three books that Angell reviews in her article, by far the most interesting one is Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, by Robert Whitaker. Anyone who thinks that psychiatric drugs are based on sound science should read this book. Whitaker argues that the very drugs that are designed to treat mental illness are actually causing the current epidemic of mental illness. Skeptical? Read the book.

    Incidentally, Marcia Angell’s article created a good deal of controversy (as you might expect). She responds to her critics here.

  3. I actually work in a community center where our PCP’s that actually do prescribe and they also diagnose. The also refer patients out to get services but unfortunately where I live, we do not have very many psychiatrists and the one place people without insurance can go has a 2-3 year waiting list. So your reality and our reality is different because our problem is that we dont have the resources and even when or if we would, people cant afford to see a psychiatrist. So what would you prefer? for them not to start them on something because they dont have any place to refer them to or for lack of insurance or resources?

    • I am having a very hard time believing a community mental health type program is telling people legitimately that people have to wait 2 YEARS or more to be seen. I have worked in some overworked sites in my career, but NO PLACE has ever told people they had to wait more than 3-4 months, and pts may not be able to be seen in 4 weeks for follow up, but they could get into the system.

      If this referral program is getting away with this, that is either due to this is the only program in the state you are in, or, they are cherry picking and hiding behind some incredibly lame excuse to get away with it.

      Doctors who are responsible and attentive should be reviewing their pt population being followed and discharge the “deadwood” that is not being compliant and cooperative every 3 to 6 months to free up spaces to see new patients. Every practice has deadwood or have other pts that can be referred out if stable and not being seen more often than 4-6 months for meds alone management.

      Another observation that some collegues will seethe upon reading: milking the system to make people come monthly for med checks for many months to years is simply unacceptable. Start seeing patients in 2-3 month intervals and what happens, a few diag slots open up each week! Maybe people need to know that reimbursement for evals is not so great, but in the end, being seen as a reliable and effective resource will recoop some of those fund losses today at the end of the year.

      • Where I live here in Canada, it took a full year before I was able to see a psychologist for a proper diagnosis. The year long wait is the norm here.

  4. As I commented at another posting’s thread here about this article, one of the problems that I have heard from various colleagues in primary care settings is the lack of reasonably quick access to psychiatrists when a somatic physician sees a patient in mental health crisis/struggle and responsibly identifies the patient’s needs are beyond the scope of the active provider’s abilities. Frankly, to hear that psychiatrists have a 2 to 3 month wait for seeing a patient for a diagnositc evaluation is, well, sad to hear, if not ludicrous to rationalize.

    As far as I am concerned, a primary dynamic to this delay in care is insurance driven. As I have commmented before here and other places on the internet, when someone opens their wallet and flashes cash, why is it an appointment is available sooner? This is an issue my profession needs to address now and do so effectively.

    But, know this, if anyone writes a prescription for a med they do not have complete comfort prescribing, that alone should be a warning flag for the provider to heed before proceeding further.

    And to you all out there as patients, until proven otherwise, no PCP or other primary care provider type does NOT have a strong backround to prescribe antipsychotics, which are now being vigorously pursued for indications beyond schizophrenia and true legitimate interventions for bipolar disorder.

    That will be the next post here or elsewhere on the internet in the coming year when we learn that more prescriptions for Abilify/Seroquel/Zyprexa and other associated meds are being written by non psychiatrists. And if that does not get redirected quickly, watch Obamacare find a reason to say psychiatry is an inconsequential specialty and be phased out for the general public to access for true needs.

    The antipsychiatrists may smile with glee to that last sentence, but, watch out for what you wish for. Psychotropics are going to be written for appropriately or not for years to come, so do you want to have trained providers dispensing them, or, government lackies?

  5. I am in complete agreement with Dr Grohol – giving out antidepressants like candy. Most everyone I know pops one. My PCP once prescribed me Zoloft because I was moving out of state and would be undergoing alot of stress. Yikes! Being a registered nurse, I was onto the game of doctors and pharmaceuticals scratching each other’s back, and declined the script.
    The problem, as I see it, is that we (society) need a quick fix to everthing now. COPING skills are not necessary anymore-you can pop an antianxiety pill any time you feel “uncomfortable”, an antidepressant when you are grieving or sad about something that SHOULD make you sad-it’s called being NORMAL. The part that really irks me is children seeing their parents manage their lives with pills. The behavior perpetuates, then we have little kids who have a meltdown when their Lego toy falls apart. An ADHD or anxiety diagnosis is sure to follow, then meds, and on and on it goes.
    I am doing my part volunteering as a mentor at my local high school (and elementary if they’ll let me do both) to help at-risk kids, teach them coping skills, relaxation techniques, healthy eating, exercise etc. Anybody who wants to do your part should check out opportunities in your community.

    • I am living in a European country with socialized medicine. When I went to the cardiologist, complaining of chest pain and stress. The specialist told my GP that I suffered from Stress disorder and that there was nothing wrong with me. He decided to label me after a 10 minute consult. He prescribed an antidepressant, even though I told him I was stressed due to my job, not depressed. He added a Psychiatric recommendation on top of that. I declined the antidepressants and the shrink. Once labeled as “mental”, I was treated as mentally ill by every doctor that I saw at that hospital. I had a heart attack 8 months later, requiring multiple stenting of my heart arteries. The cardiologist was wrong about my heart problems, maybe they should realize that he was also wrong about the depression diagnosis also.

  6. I completely agree that primary physicians are over prescribing antidepressant medications without formally diagnosing the patient with mental illness. I am a psychiatric technician and I work for Napa State Hospital and I know what these medications are for and the side affects associated with these medications. What I have also seen is that some primary physicians do not take in to considerations the patients culture and customs, and if the patient is not giving them eye contact, they misdiagnose them and prescribe antidepressants. I have seen when some of my family members whent for a regular check up and come back with antidepressant medications. I am doion my part to educate my community about mental illnesses through my blog. ( I think when primary physicians suspect mental illness the best thing to do is to consult with a psychiatrist or psychologist.

  7. I am writing this because my pcp recently denied my Zoloft refill when I told her assistant I could not afford to come in for a medication review. After ten-plus years I am now in withdrawal, alone, and angry. The denial may be a blessing someday…for now I am not sure minute-to-minute and feel I brought this on myself because I did not see this fall coming.
    There were times over the years that I questioned the treatment I was receiving or maybe I should say not receiving. I was convinced I needed the Zoloft because whenI starteed the medication a psychiatrist prescribed it and within a few weeks I noticed an even calm and reduced anxiety that I had never in my life felt. I won’t go into my life history but it does not include many happy events, many not of my creation, some I own and take responsibility for. Well, my psychiatrist died, and the psychologist I was seeing on a weekly basis told me she killed herself. I had not seen her for awhile and felt badly that she was so distressed. I was not sure what I would do about my medication refill needs and then my psychologist suggested I speak with my pcp. That solved the problem and in time I stopped seeing the psychologist and just continued rolling along taking the Zoloft without a plan. I share responsibility with everyone involved and am left now to “fix” this problem alone. I am learning that free medical care is not easy to find in Texas.
    Last year I lost my job, insurance, and will soon be without a home if I cannot find a job soon. I was lucky to have the insurance funds to pay for my last medication review in June 2010. At that time my pcp filled my RX for Zoloft for another year without a hitch. I thought surly I would have a job before the next review came around. Still no job, at the end of June 2011 and when I could not pay for a medication review my pcp said she would give me one additional month but told me I would need to find a new medical care provider. I started looking for new care provider and my pharmacist called in the refill request. That was a couple of weeks ago. The pharmacist sent in several refill requests but did not receive a response and then yesterday I received a phone call. My pcp changed her mind and denied the refill request. The pharmacist called me and apologized. It would be impossible for me to call and beg my pcp becuase I feel betrayed for some reason.I have not found a replacement physcian an I am feeling the physical and emotional withdrawal symptoms that go with not taking Zoloft. If I can make it through the next couple of weeks,I think it might be for the best, if I don’t start taking it again.
    Well that is my story for what it is worth.
    I think I will read some of the information published by Dr.Angell. Thank you for listening.




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