Americans Using Antidepressants Without Proper Diagnosis

Nearly 25 percent of all Americans taking antidepressants have never received any diagnosis from a specialist for any conditions the drugs are used to treat, according to new research from the University of Manitoba.

Researchers say that millions of people could be taking medicines that have no proven health benefits and are exposed to side effects they do not need.

“We cannot be sure that the risks and side effects of antidepressants are worth the benefit of taking them for people who do not meet criteria for major depression,” said Jina Pagura, a medical student and psychologist at the University of Manitoba in Canada, who worked on the research.

“These individuals are likely approaching their physicians with concerns that may be related to depression, and could include symptoms like trouble sleeping, poor mood, difficulties in relationships, etc,” she told Reuters Health by email. “Although an antidepressant might help with these issues, the problems may also go away on their own with time, or might be more amenable to counseling or psychotherapy.”

Pagura and colleagues used data from the Collaborative Psychiatric Epidemiologic Surveys, which includes a perspective sample of more than 20,000 US adults interviewed between 2001 and 2003.

About 10 percent of the sample told interviewers they had been taking antidepressants during the past year. Yet nearly a quarter of those people had never been diagnosed with any conditions usually treated with that type of medication, such as depression and anxiety.

Nearly 15 million American adults suffer from major depression, and another 40 million have some type of anxiety disorder, according to the National Institute of Mental Health.

Although all forms of mental illness were not included in the survey, mental health experts said the new findings are not exaggerated.

“Reviews of claims records, which are diagnoses actually given by health care professionals, suggest that only about 50% of patients who are prescribed antidepressants receive a psychiatric diagnosis,” Dr Mark Olfson, a psychiatrist at Columbia University in New York, told Reuters Health in an email.

“These findings raise questions about the clinical appropriateness of antidepressant treatment selection for many primary care patients,” he added.

The sale and use of antidepressants in the United States currently ranks fourth among all prescription drugs, according to IMS Health, who said sales in 2009 reached nearly $10 billion, up three percent from the previous year.

While studies show that antidepressants may help some people with depression, they come with a cost. Beside the $100+ monthly price tag on many antidepressants, some users may experience sexual problems or gain weight when using them.

“Nearly all medication has side effects, so there are undoubtedly a large number of Americans who are taking antidepressants that may not be effective at treating their conditions, yet they suffer from the side effects,” said Jeffrey S. Harman, a health services expert at the University of Florida in Gainesville, who was not involved in the research.

“Not to mention inappropriate use of our health care dollars that comes along with inappropriate prescribing,” he added.

The findings do not necessarily mean doctors are prescribing more antidepressants than they should, however, said Harman. “As far as over-prescribing, I don’t think you can say that it is occurring as a blanket statement “¦ there are undoubtedly many people being prescribed antidepressants that may not be effective for them, but there are also millions of Americans suffering from depression who are not being prescribed antidepressants or are being prescribed them at a suboptimal dose,” he explained.

Although not commenting directly on the new research findings, Pfizer told Reuters Health that it was dedicated to ensuring “that patients and their doctors have the most up to date medical information on which to base their treatment decisions.”

The new research was published in the Journal of Clinical Psychiatry.

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