Antidepressants Are over Prescribed Essay Example

Antidepressants Are over Prescribed Essay Example Antidepressants Are over Prescribed Essay Antidepressants Are over Prescribed Essay Antidepressants are overprescribed Mitrea (2007) defines antidepressants as an agent or a drug that is most commonly used to prevent or treat depression. However, in today’s society it could be said that antidepressants are being over prescribed and are being used to treat a vast range of other conditions, as well as clinical depression. When the first antidepressant was developed, manufacturers were reluctant to put it on the market due to the extremely low number of people suffering from depression. Now, antidepressant drugs have a very dominant place in the drug market, with studies showing that they are now one of the most widely prescribed categories of drugs (Mark 2010). There could be a number of reasons for this increase in antidepressant prescriptions; more people in today’s society could be suffering from depression, or the drugs could indeed be being over prescribed by doctors. This essay will aim to critically discuss whether antidepressants are being over prescribed or perhaps under prescribed, and if the diagnosis for depression needs to be reviewed in order to prescribe antidepressants more appropriately. Various studies have been carried out that aim to show that the proportion of antidepressants being prescribed without a psychiatric diagnosis is growing, concluding that antidepressant drugs are being overprescribed. Research by Mojtabai Olfson (2011) found that the increase over the years has come from prescriptions written by non-psychiatrist providers, for patients who do not have a psychiatric or mental health diagnosis. Antidepressants are not being prescribed solely for depression; they are also used to treat chronic pain, anxiety, panic disorder, obsessive compulsive disorder and even eating disorders (Parker 2005). The symptoms for depression are a depressed mood, taking less pleasure in life, lack of energy, changes in appetite, restless habits, feeling worthless and guilty, and suicidal thoughts (American Psychiatric Association [DSM-IV-TR], 2000), but even with these parameters, it can still be difficult to distinguish severe depression from natural periods of feeling â€Å"down. Mojtabai Olfson (2011) reviewed a national sample of office based physician visits over a one week period. They compared visits that involved the prescription of antidepressants with no psychiatric diagnosis with visits that involved the prescription of antidepressants with a psychiatric diagnosis. The findings showed that in the general medicine practice, the use of antidepressants was more dominant among people wi th mental health conditions that were considered less severe and that were poorly defined (John Hopkins University Blomberg School of Public Health 2011). To the extent that antidepressants are being prescribed for uses not supported by clinical evidence, it may be beneficial to improve provider’s prescribing practices, review drug formularies, or pursue interventions that will increase and encourage communication between primary carers and mental health specialists. The rising number of antidepressant prescriptions raises questions not only about over prescription but also about misdiagnoses. It could be fair to say that doctors are too quick to hand out prescriptions for any emotional problem. The rise in prescriptions could be down to patients being diagnosed with depression when they are in fact suffering from different health issues. Researchers have been investigating whether people who have been told they are suffering from depression actually have undiagnosed hypothyroidism (Garber 2006). Hypothyroidism is a disease in which the thyroid gland fails to produce enough thyroid hormone (Andrews 2010). The symptoms of this disease can mimic the symptoms of depression, and it could be possible that the growth in antidepressant prescribing is going to the community of undiagnosed thyroid patients. It is fair to ask why doctors tend to hand out a prescription for an antidepressant rather than run thyroid tests. The answer to this is most likely to do with time and money. It is much quicker for doctors to write a prescription for an antidepressant drug than to question patients about their health history (Shomon 2011). Macdonald et al. (2009) suggest that the current levels of antidepressant prescribing needs to be assessed. In this study, which gave an insight into General Practitioners (GPs) perspectives on the rise of antidepressant prescriptions, it was evident that many GPs believed that unhappiness, exacerbated by social deprivation and the breakdown of traditional social structures, was being ‘medicalised’ inappropriately (Macdonald et al. 2009). However, participation in this study was voluntary so it is very likely that GPs who were interested in mental health and comfortable with their own prescribing practice would be more likely to take part, thus raising the question; are antidepressants really overprescribed? Despite the increasing number of studies on the over prescription of antidepressants some support this rise in antidepressant use, arguing that it is better to diagnose depression too often and too little (Barber 2008). Research has also been conducted not on over prescription, but in fact under prescription of antidepressants. These researchers are challenging the wide-spread assumption that doctors are handing out antidepressants too often, and suggest that they are in fact being underused instead of overused. In contrast to the study by Macdonald et al. (2009), Cameron et al. (2009) challenged the hypothesis that GPs prescribe antidepressants to patients who are unlikely to require them. The findings suggest that the recent accounts of the overuse of antidepressants are unwarranted. The prescribing of antidepressants to those patients who were not symptomatic was accounted for by relapse prevention, and for the ongoing successful treatment of previously identified depression. Among the patients with probable depression, half did not have their symptomatic status identified and were not offered any treatment for depression, suggesting that GPs may under prescribe, rather than over prescribe antidepressants (Cameron et al. 2009) The increasingly common belief that antidepressants are being over prescribed is mainly down to the fact that the number of antidepressant prescriptions has significantly risen over the last few years. However, when researchers looked more closely at antidepressant prescribing activity, they found an altogether different situation, which showed that only a very small number of patients were being given such drugs without reason (Reid 2009). The main aim of the study was to investigate whether patients who did not meet the criteria laid out in the national guidelines were unnecessarily being prescribed antidepressants, which are also often used to treat pain. The findings showed that only 3 out of a total of 897 patients who took part in the study were being given an antidepressant drug unnecessarily. Many patients who met the criteria in the national guidelines and qualified for treatment with antidepressants were not being given them, which adds to the assumption that GPs are significantly under diagnosing the condition of depression. According to Reid (2011), the assumption that antidepressants are being over-prescribed is being fuelled by the way in which statistics are currently being used to analyze the situation. He says that the numbers are only based on the volume of prescriptions and do not provide any information on differences in the dose or the duration of therapy. Currently, the statistics measure the number of prescriptions being handed out for antidepressant drugs. Critically, they don’t give any indication of how many people are actually taking the drugs. If the doses of antidepressants increased, or the duration of the treatment was extended, there would be an increase of the prescription statistic without any change in the number of people being treated (Reid 2011). The arguments about the over and under prescribing of antidepressants raises an important question; Are antidepressants really effective at treating depression and should they even be prescribed at all? Studies suggest that the popular antidepressant drugs are no more effective that an placebo. Kirsch (1998) investigated this claim by comparing the improvement in patients taking antidepressants with the improvement in those taking placebo pills and found that the difference was minuscule. Patients on a placebo improved about 75% as much as those on actual antidepressants (Begley Kliff 2010). From these findings it is evident that three quarters of the benefit from antidepressants seems to be a placebo effect. It can be argued that these publications that claim that antidepressants don’t work any better than a placebo are a highly misleading interpretation of evidence that shows that antidepressants do work, even in less severely depressed patients, with the long term benefits of the drugs showing an even stronger effect (Melander et al. 008). Geddes et al. (2003) states that the ability of antidepressants to prevent further episodes of depression is one of the strongest findings in the whole of medicine. Placebo does have an impact on mood when used in clinical trials, but the effect is much less than that of antidepressants. Moreover, if the effects of antidepressants are compared with those of no treatment, as is sometimes done for psychotherapy trials, then the effects of drug treatments are as big as those of talking therapies (Nutt Sharpe 2008). Most GPs agree with the claim that antidepressant prescriptions are indeed being overprescribed without a proper diagnosis, and studies suggest that prescribing behaviour needs to change in order to reduce this rising level of prescribing (Macdonald et al. 2009). However, as far as overprescribing, it is not fair to say that it is occurring as a blanket statement. There is evidence to suggest that antidepressants are not prescribed nearly enough and that depression is significantly under diagnosed, meaning that patients who should be treated with antidepressants are not being offered them. There is no definitive answer to whether or not antidepressants are under or over prescribed, but it fair to suggest that the national guidelines for the treatment and diagnosis of depression needs to be reviewed, and doctors need to be educated in distinguishing severe depression from natural periods of sadness and perhaps start providing alternatives to prescribing antidepressants such as counselling to address the main problems of depression rather than masking the symptoms. As far as antidepressants being effective, it is clear that the drugs have been very beneficial to millions of people (Begley Kliff 2008). However, antidepressant drugs are perhaps not necessarily the best choice of treatment. Psychotherapy, for instance, works for moderate, sever, and even very severe depression. It would be beneficial for further research to be conducted to determine if antidepressants are being prescribed for a misdiagnosis of depression or if GPs are missing cases of depression and therefore not prescribing antidepressant drugs enough. References American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (Revised 4th edition) Washington DC: Author Andrews, L. W. (2010) Encyclopaedia of Depression (Volume 1) USA: ABC-CLIO, LLC Begley, S. Kliff, S. (2010) The depressing news about antidepressants Newsweek Vol. 155, No. 6, pp 34-41 Barber, C. (2008) Comfortably Numb: How psychiatry is medicating a nation New York: Vintage Books Cameron, I. M. , Lawton, K. , Reid, I. C. (2009) Appropriateness of antidepressant prescribing: An observational study in a primary-care setting. British journal of General Practice 59: 644-649 Garber, J. R. (2006) Clinical Update: Managing the challenges of hypothyroidism Journal of Family Practice Vol. 55, No. 66, pp 51-8 Geddes, J Carney, S, Davies, C Furukawa, T Kupfer, T, Frank, E. Goodwin G (2003) Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. The Lancet 361(9358): 653? 661 John Hopkins University Blomberg School of Public Health (2011) Prescriptions for antidepressants increasing among individuals with no psychiatric diagnosis, US study finds. Science Daily Retrieved October 19th 2011 from sciencedaily. com/releases/2011/08/110805135808. htm Macdonald, S. , Morrison, J. , Maxwell, M. , Munoz-Arroyo, R. , Power, A. , Smith, M. , Sutton, M. , Wilson, P. (2009) ‘A coal face option’: GP’s perspectives on the rise in antidepressant prescribing British journal of General Practice Vol. 59, No. 566, pp. e299- e307 (9) Mark, T. L. (2010) For what diagnosis are psychotropic medications being prescribed? : A nationally representative survey of psysicians CNS Drugs 24(4): 319-326 Melander et al (2008) A regulatory apologia ? a review of placebo? controlled studies in regulatory submissions of new? generation antidepressants. European Neuropsychopharmacology 18: 623? 627 Mitrea, L. S. , (2007) Natural Medicone Mosiac, Volume 1. Canada: Natural Medicne Books Mojtabai, R. Olfson, M. (2011) Proportion of antidepressants prescribed without a psychiatric diagnosis is growing Health Affairs, 30(8) Nutt DJ and Sharpe M (2008) Uncritical positive regard? Issues in the safety and efficacy of psychotherapy. Journal of Psychopharmacology 22: 3? 6 Parker, G. (2005) Beyond major depression Psychol Med 35: 467-72 Reid, I. (2009) Antidepressants are under – not over – prescribed British Journal of General Practice Shomon, M. (2011) More antidepressants being prescribed without a psychiatric diagnosis: Are undiagnosed thyroid problems a key cause? Retrieved on October 20th from http://thyroid. about. com/b/2011/08/15/antidepressants-thyroid-depression-shames. htm