Psychiatrist Warns Too Many Unnecessary Prescriptions for Antidepressants
Antidepressants are the most prescribed drugs in America with one in 10 Americans taking one, and in women in their 40s and 50s the statistic is one in four. Are we a nation that is quick to turn to pills that make us feel better? Are these drugs overprescribed? What’s the solution?
Psychiatrist Prakash Masand, M.D., CEO of Global Medical Education (GME), an online medical education resource, and a former consulting professor of psychiatry and behavioral sciences at Duke University Medical Center, says a lot of people taking antidepressants shouldn’t be – and physicians, patients and insurance companies have, in a sense, become complacent and often look for a “quick fix.” Paradoxically, there are many patients with clinical depression who are not in treatment, partly because of stigma.
How do we fix the problem?
Dr. Masand recommends:
- Increased psychiatric training – Non psychiatric physicians, nurse practitioners, physician assistants and other extended care providers handle more than 90% of psychiatric care in the U.S., yet only receive 6 to 12 weeks of training in psychiatry over their entire medical school and residency careers. With pressure from managed care companies and the average visit being around 18 minutes, it is very tempting to write a prescription rather than discuss non-pharmacological options.
- Caution with DSM-5 bereavement exclusion – According to the new DSM-5 released by the American Psychiatric Association, a person impacted by the loss of a loved one no longer has to wait a two month period to be diagnosed with depression. This is a very slippery slope as physicians are going to be even more inclined to prescribe drugs for depression, when it’s really just normal grief.
- Focus on other therapy – Interpersonal therapy and cognitive behavioral therapy have both been shown to be as effective as antidepressants in the treatment and maintenance of mild to moderate depression which is primarily what is seen in non-psychiatric settings. Exercise and self-help groups also make a huge difference for someone with depression. Antidepressants are indeed very helpful, but certainly not necessary for a lot of people currently taking them, and side effects often occur. Besides, there is an acute shortage of psychiatrists and also therapists well-trained to provide CBT and IPT. Insurance companies would often rather pay for a generic antidepressant than approve 12 sessions of therapy.
- Improve diagnostic accuracy – Both physicians and the public are often misled on what depression is and this can lead to a misdiagnoses as recent studies have shown. Clinical or major depression requires that patients have five out of nine specific symptoms (i.e. suicidal preoccupation, loss of interest in all or most pleasurable activities, feelings of guilt, lack of energy, etc.) over a two week period. Many people treated with antidepressants often have an adjustment disorder related to stressors that can respond well to therapy.