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.
Melissa Healy, writing for the LA Times has the story:
In the 12-year period leading up to 2007, almost 1 in 10 visits to primary care physicians (9.3%), resulted in the patient coming away with a prescription for an antidepressant, the study found. But in only 44% of such cases did the doctor make a formal diagnosis of major depression or anxiety disorder. […]
That trend escalated between 1996 and 2007, as both primary care physicians and specialists stepped up their prescribing of antidepressants. Even as they did so, fewer and fewer of the patients who got those prescriptions got a psychiatric diagnosis along with their pills, the authors found.
The real problem here is that doctors are prescribing the treatment, but not making the diagnosis. It’s like they’re saying, “Well, yeah, I understand antidepressants were developed only for the treatment of a serious mental disorder. But I’ll treat them like a placebo and hand them out even when I don’t make the diagnosis.”
Either doctors are shirking their diagnostic duties here for little good reason, or they simply believe antidepressants are some sort of magical pill that lifts mood without otherwise impacting an individual.
One excuse offered in the article is that because doctors haven’t always made the necessary partnerships with mental health professionals, they can’t provide the full scope of care their prescription would suggest. “One problem, says Huffman: Primary care physicians and medical specialists rarely have partnerships that would make a mental health professional easily accessible to their patients.”
I don’t buy this. Making such professional alliances in most communities is easy and simple. It’s more likely there are too few psychiatrists to refer to, or their waiting list is months long. Or there’s continuing prejudice toward mental disorders being reinforced by the primary care physician. Instead of using the opportunity as a teaching moment, some of these doctors appear to want to sweep things under the rug.
If your family doctor or general practitioner has given you a prescription for an antidepressant without a recommended specialist followup — with a psychiatrist or psychologist, for instance — they are providing you an inferior level of care. They are also not doing their job if they aren’t giving you a preliminary mental disorder diagnosis along with that prescription… So much so, I would consider dumping them as my doctor.
Antidepressant medications aren’t candy. Neither are they cure-alls for simply feeling a little down or lacking the energy one would normally have. Their prescription in the role of a placebo is another sad indicator that there are simply some family doctors out there who still don’t “get it.” And probably never will.
Read the full article: Antidepressants in primary care: Is this how to treat depression?
Grohol, J. (2018). Antidepressants Overprescribed in Primary Care. Psych Central. Retrieved on November 30, 2020, from https://psychcentral.com/blog/antidepressants-overprescribed-in-primary-care/