{"id":11756,"date":"2011-08-08T10:01:36","date_gmt":"2011-08-08T14:01:36","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=11756"},"modified":"2011-08-08T13:59:38","modified_gmt":"2011-08-08T17:59:38","slug":"medicine-at-its-worst","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/08\/08\/medicine-at-its-worst\/","title":{"rendered":"medicine at its worst…"},"content":{"rendered":"
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More Antidepressants Are Given Without Diagnosis<\/font><\/strong><\/a><\/u>
Pharmalot<\/font><\/strong>
by Ed Silverman<\/sup>
August 5th, 2011<\/div>\n

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.<\/sup><\/strong><\/p>\n

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…<\/sup><\/strong><\/p>\n

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…<\/sup><\/strong><\/div>\n<\/blockquote>\n
Here’s the referenced abstract… <\/div>\n
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Proportion Of Antidepressants Prescribed Without A Psychiatric Diagnosis Is Growing<\/font><\/strong><\/u><\/a>
by Ramin Mojtabai and Mark Olfson<\/sup>
Health Affairs<\/font><\/strong> [2011] 30:1434-1442.<\/div>\n

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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.<\/sup><\/strong><\/div>\n<\/blockquote>\n
Here lies the essence of the issue raised by Drs. Mojtabai and Olfson – they propose that we "vigorously pursue implementation of broad reforms of the health care system that will increase communication between primary care providers and mental health specialists," thinking that this rise in the inappropriate prescription of antidepressants might be curbed if the primary care physicians would communicate more with psychiatrists. That’s completely wrong, totally backwards. This rise in the inappropriate prescription of antidepressants is because of<\/u> the communication between primary care providers and mental health specialists – specifically psychiatrists [kols] on pharmaceutical speaker’s bureaus who travel the country touting the wonders of the antidepressants, implicitly [and explicitly] encouraging their use [aided by patient requests from the television ads that end, "Ask your doctor if antidepressant x<\/em> is right for you"].<\/div>\n

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That’s the whole point of this and many other blogs that endlessly document the fact that the pharmaceutical companies have paid many millions of dollars to psychiatrists to actively teach<\/u> primary care physicians to give their patients antidepressants. In my last post, I mentioned a ghostwritten editorial<\/strong><\/u><\/a> "authored" by several prominant psychiatrists saying:<\/div>\n