1 Boring Old Man

More Antidepressants Are Given Without Diagnosis
Pharmalot
^{by Ed Silverman}
August 5th, 2011

^{Should a patient first be diagnosed with a psychiatric problem before receiving a prescription? Well, nearly 73 percent of antidepressants prescribed in the US in 2007 were generated without a psychiatric diagnosis, up from nearly 60 percent in 1996. And the percentage of antidepressants prescribed to patients without a diagnosis more than doubled to 6.4 percent from 2.5 percent of all visits to docs who were not psychiatrists, according to a study in Health Affairs.}

^{To be more specific, among primary care providers, antidepressant prescriptions rose from 3.1 percent during that period to 7.1 percent. And among other docs who are not psychiatrists, visits without a psychiatric diagnosis grew from 1.9 percent to 5.8 percent. Meanwhile, antidepressants prescribed with a psychiatric diagnosis increased to 2.4 percent from 1.7 percent…}

^{Although the researchers acknowledge the results do not specifically indicate a rise in inappropriate use of antidepressants, they argue the findings suggest that antidepressants are being prescribed for uses not supported by clinical evidence. They noted that patients who were prescribed the pills by docs other than psychiatrists and not diagnosed with a psychiatric disorder tended to suffer from diabetes, heart disease, or multiple medical conditions; have excessive fatigue and headaches; and to complain of nonspecific pain or abnormal sensations…}

Proportion Of Antidepressants Prescribed Without A Psychiatric Diagnosis Is Growing
^{by Ramin Mojtabai and Mark Olfson}
Health Affairs [2011] 30:1434-1442.

^{Over the past two decades, the use of antidepressant medications has grown to the point that they are now the third most commonly prescribed class of medications in the United States. Much of this growth has been driven by a substantial increase in antidepressant prescriptions by nonpsychiatrist providers without an accompanying psychiatric diagnosis. Our analysis found that between 1996 and 2007, the proportion of visits at which antidepressants were prescribed but no psychiatric diagnoses were noted increased from 59.5 percent to 72.7 percent. These results do not clearly indicate a rise in inappropriate antidepressant use, but they highlight the need to gain a deeper understanding of the factors driving this national trend and to develop effective policy responses. 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 vigorously pursue implementation of broad reforms of the health care system that will increase communication between primary care providers and mental health specialists.}

^{The weight of evidence is so persuasive that there should never again be a valid reason for not aggressively seeking out and treating depression in medically ill patients. Increasing awareness, reducing stigma, and maintaining a high level of vigilance for depression in medically ill patients must become a priority for clinicians.}

Update: Oh look! They’re reporting the same phenomenon with the Atypical Antipsychotics. My comment: "Ditto!". Hat Tip to Soulful Sepulcher!

National Trends in the Antipsychotic Treatment of Psychiatric Outpatients With Anxiety Disorders
^{by Comer JS, Mojtabai R, and Olfson M.}
American Journal of Psychiatry 2011 Jul 28. [Epub ahead of print]

^{Objective: The purpose of the present study was to examine patterns and recent trends in the antipsychotic medication treatment of anxiety disorders among visits to office-based psychiatrists in the United States.}

^{Method: Annual data from the 1996-2007 National Ambulatory Medical Care Survey were analyzed to examine the patterns and trends in antipsychotic medication treatment within a nationally representative sample of 4,166 visits to office-based psychiatrists in which an anxiety disorder was diagnosed.}

^{Results: Across the 12-year period, antipsychotic prescriptions in visits for anxiety disorders increased from 10.6% (1996-1999) to 21.3% (2004-2007). Over the study period, the largest increase in antipsychotic prescribing occurred among new patient visits. Antipsychotic prescribing also significantly increased among privately insured visits and visits in which neither antidepressants nor sedative/hypnotics were prescribed. Among the common anxiety disorder diagnoses, the largest increase in antipsychotic medication treatment was observed in visits for panic disorder. Antipsychotic prescribing rose from 6.9% (1996-1999) to 14.5% (2004-2007) among visits for anxiety disorders in which there were no co-occurring diagnoses with an indication approved by the Food and Drug Administration for antipsychotic medications.}

^{Conclusions: Although little is known about their effectiveness for anxiety disorders, antipsychotic medications are becoming increasingly prescribed to psychiatric outpatients with these disorders.}