Prescriptions for antidepressants increasing among individuals with no psychiatric diagnosis

"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, MD, PhD, MPH, lead author of the study and an associate professor with the Bloomberg School's Department of Mental Health. "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."

Using data from the 1996-2007 National Ambulatory Medical Care Surveys, researchers reviewed a national sample of office-based physician visits by patients ages 18 years and older during a one-week period. They conducted two sets of logistic regression analyses, comparing 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 and published in the Journal of Affective Disorders examined the impact of expansion of antidepressant use on the prevalence and characteristics of depression and suicidal ideations. That study found that antidepressant use significantly reduced the prevalence of more severe depression and suicidal ideations among individuals with sever 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," adds Mojtabai. "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."

Provided by Johns Hopkins University Bloomberg School of Public Health