Are Antidepressants Being Overprescribed?

It is rare that someone comes to my psychiatric practice for the first time not currently taking an antidepressant or having taken one in the past. In discussions with my internal medicine colleagues, they frequently comment on the increased use of this class of medications in their patient populations. So, a frequent question is:  Are antidepressants being overprescribed?

A recent published study looked at the use of antidepressants in 2005 compared with 10 years prior. During that time, the use of antidepressants nearly doubled, from 5.8 percent of the population to 10.1 percent. The increases were seen across all adult demographic groups. Interestingly, the percentage of people who were on antidepressants and also received psychotherapy declined significantly, from 31.5 percent to 19.8 percent. Also, only one in four individuals taking an antidepressant in 2005 was being treated by a psychiatrist.

There are several reasons given for the increased use of antidepressants. There are more medications available for use, they are typically well-tolerated, and there is generally less stigma of mental illness with a growing acceptance of drug treatment by the public. There has also been a significant increase in direct-to-consumer advertising for antidepressant drugs. Additionally, the indicated use for antidepressants has expanded beyond pure depressive illness. For example, these medications are also used to treat pain, anxiety, fatigue and sleep disorders.

There is also the suggestion that prevalence of major depression may be increasing in the general population, or at least people are more willing to disclose that they have depression. A recent study in New Zealand suggested that by age 32, about 41 percent of the population had experienced depressive symptoms in their lifetime. This was a fairly rigorous study and the results were much higher than the typical self-report surveys that find the prevalence of depression to be about half of what the New Zealand study found.

Are antidepressants overprescribed? A more accurate question is whether individuals with depressive symptoms are getting appropriate treatment. Clearly not every individual with depressive symptoms needs an antidepressant medication. It is concerning that the use of psychotherapy is diminishing. Psychotherapy can be a very effective treatment for depressive symptoms but the time and expense can lead to its underutilization. Exercise can be effective treatment for depression, but persuading a sedentary depressed person to exercise is a tall order.

In 2004, the Food and Drug Administration issued a series of public warnings about the increased risk of suicidality in young patients associated with antidepressants. Since that time, it is believed that the use of these medications in children and adolescents has diminished about 18 to 20 percent. Interestingly, concurrent with the decreased use of antidepressants in this age group, the rate of child and adolescent suicides increased 18 percent. Coincidence?

(Dr.  Hart is Clinical Director of Adult Services for Rolling Hills Hospital in Franklin, TN. If you or a family member are in crisis from any behavioral health issue, you may call 1-800-832-0388 for assistance.)

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