Nearly 80 percent of all prescriptions for antidepressants are written by non-psychiatrist providers, and of those almost three-quarters are not accompanied by any psychiatric diagnosis.
That is the thrust of a new study that details how antidepressant use in America has grown over the past two decades. Researchers report antidepressants are currently the third most commonly prescribed class of medications in the U.S., and one of the most costly.
According to the Centers for Disease Control and Prevention, from 2005-2008 nearly 8.9 percent of the U.S. population had at least one prescription in this drug class during any given month.
The study reviews national trends in antidepressant prescribing and finds much of this growth was driven by a substantial increase in antidepressant prescriptions by non-psychiatrist providers without any accompanying psychiatric diagnosis.
Study findings are featured in the current issue of Health Affairs.
“We’ve seen a marked increase in antidepressant use among individuals with no psychiatric diagnosis. Nearly four out of every five antidepressant prescriptions are written by non-psychiatrist providers,” said Ramin Mojtabai, M.D., Ph.D., M.P.H., lead author of the study.
“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 and the share of providers who prescribed antidepressants without a concurrent psychiatric diagnosis increased from 30 percent of all non-psychiatrist physicians in 1996 to 55.4 percent in 2007.”
Researchers reviewed a national sample of office-based physician visits by patients ages 18 years and older during a one-week period. They compared antidepressant visits lacking psychiatric diagnoses with antidepressant visits including psychiatric diagnoses and visits lacking both prescriptions for antidepressants and psychiatric diagnoses.
In addition, Mojtabai and colleagues assessed physician practice-level trends in antidepressant visits without psychiatric diagnosis and found that in the general medicine practice, antidepressant use was concentrated among people with less severe and poorly defined mental health conditions.
An earlier study led by Mojtabai found that antidepressant use significantly reduced the prevalence of more severe depression and suicidal ideations among individuals with severe depressive episodes.
The findings lead researchers to recommend that antidepressants be prescribed primarily to individuals with severe depression or a confirmed psychiatric diagnosis.
“With non-specialists playing a growing role in the pharmacological treatment of common mental disorders, practice patterns of these providers are becoming increasingly relevant for mental health policy,” Mojtabai said.
“To the extent that antidepressants are being prescribed for uses not supported by clinical evidence, there may be a need to improve providers’ prescribing practices, revamp drug formularies or undertake broad reforms of the health care system that will increase communication between primary care providers and mental health specialists.”