Americans are popping more antidepressants than ever before to deal with everyday stress, and non-psychiatrists are increasingly willing to prescribe the drugs to patients with no mental health diagnosis, a new study finds.
Antidepressants such as Prozac, Paxil and Lexapro are now the third most widely prescribed group of drugs in the United States, and many people may take them for minor complaints without being fully aware of potential risks, the researchers said.
"Both consumers and prescribers of antidepressants should be more knowledgeable about the indications (or symptoms) that antidepressants are better for," said study lead author Dr. Ramin Mojtabai, an associate professor of psychiatry at the Johns Hopkins Bloomberg School of Public Health in Baltimore. "Although these drugs do not have many acute side effects, there may be more long-term adverse effects."
The study authors said the increases don't necessarily mean that the drugs are being used inappropriately, but it's necessary to understand why antidepressant use is growing and, if necessary, to develop policies that ensure patients get the most effective treatment.
Using data from annual surveys by the U.S. Centers for Disease Control and Prevention, the researchers reviewed the records of 233,144 adult patients who made doctor visits between 1996 and 2007.
The study
found that the percentage of prescriptions for antidepressants written by non-psychiatrists more than doubled from about 4 percent to almost 9 percent over the 12-year period.
This included 9,454 antidepressant prescriptions for patients without a diagnosis of depression or other mental illness typically treated with the medication. For that group, the rate jumped from 2.5 percent at the start of the study period to 6.4 percent, the researchers said.
The study cautioned that a psychiatric diagnosis could have been made in some cases, but simply wasn't noted in the records studied.
By contrast, prescriptions for antidepressants for patients with diagnoses such as major or chronic depression increased by 44 percent, a much smaller increase.
About 4,000 patients who did have a mental health diagnosis received the drugs from non-psychiatrists in the study period.
The drugs prescribed to patients without a diagnosed mental health condition were more likely provided to white women between the ages of 35-64 and patients with public insurance and chronic medical conditions, such as diabetes and heart disease. The data also suggested that people complaining of nervousness, sleep problems, sexual dysfunction and an inability to quit smoking may be taking antidepressants, the study said.
Americans are turning to drugs to deal with everyday stress more frequently as the stigma of using antidepressants decreases, said Mojtabai, noting more than 10 percent of Americans now take antidepressants in any given year.
Direct marketing to consumers and reports of fewer side effects may help explain why patients and doctors are more open to antidepressants, he said.
But there may be consequences to that choice.
Some research has shown that withdrawal from antidepressants after many years "is not pleasant," said Mojtabai, who added that a possible link to diabetes has also been found. Not enough is known about how their use plays out in the long term, said Mojtabai.
"Pharmaceutical companies aren't interested in long-term effects because they don't need that for FDA approval," said Mojtabai, referring to the U.S. Food and Drug Administration, which approves drugs for use in the United States.
Another expert agreed that Americans are turning more to prescribed pills to deal with the ups and downs of life, but he noted that in the past, alcohol and other drugs served the same purpose.
"Before antidepressants came along, many people simply turned to drinking and smoking to cope with minor stress," said Tony Tang, adjunct professor in the department of psychology at Northwestern University in Evanston, Ill.
Although the study did not "solve the mystery" of why antidepressant prescriptions are increasing, it showed "how antidepressants are actually used in the real world," and on a "national scale," said Tang.
Doctors are likely more aware today of the symptoms of depression, which has "increased substantially in the past decade," he said.
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