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Overprescribed: When Antidepressants Make No Sense

Antidepressants can be lifesavers for people who have severe depression. However, new research reveals that they provide little to no benefit for people who have mild to moderate depression. Unfortunately, these medications are prescribed more than ever before, even simply to address normal human emotions.

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Soon after fluoxetine, which is marketed as Prozac by Eli Lilly, hit pharmacy shelves in 1988, the antidepressant was hailed as a miracle drug and made the covers of magazines. Fluoxetine and many other so-called second-generation antidepressants that followed it to market became blockbuster medications that psychiatrists widely considered to be effective at banishing depression and much safer than the antidepressants that came before them.

More than a quarter of a century later, many people attribute great life improvement to these medications, and psychiatrists widely agree that they can be lifesavers for some. What’s more, psychiatrists say many people who could benefit from the medications aren’t receiving them.

However, after a decades-long focus on getting antidepressants to patients who might need them, mental-health researchers increasingly are turning their attention to what they say is a serious problem in which patients are being prescribed antidepressants needlessly.

“Some physicians are doling them out like candy,” says Irving Kirsch, who is the associate director of Program in Placebo Studies at Harvard Medical School. “People are overdiagnosed, and these drugs are way overprescribed.”

Recent studies bear him out. For example, an analysis of a large mental-health study in the general population of Baltimore, which was published by Journal of Clinical Psychiatry in January 2015, identified 137 participants who took antidepressants that were prescribed by their doctors. When researchers reviewed the interviews of those participants, the researchers found that the interviewers hadn’t detected depression in 69 percent of the participants.

The results of our interviews with 16 mental-health-care professionals and researchers paint a disturbing picture: Doctors are playing fast and loose with their prescription pads. They’re prescribing antidepressants for low-grade mental-health complaints and even to address normal human emotions, such as unhappiness, grief and stress, experts tell us. Evidence from lawsuits and research shows that pharmaceutical companies manipulate data to inflate the benefits of their medications while downplaying—and even intentionally hiding—information on the potential harm from their medications. Perhaps most troubling is evidence of conflicts of interest that involve pharmaceutical companies and members of the organization that writes the standard classification of mental disorders that’s used by U.S. mental-health professionals and the treatment guidelines for depression that most doctors follow.

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MEDICATING NORMAL. Since 2000, the number of prescriptions for antidepressants that were filled more than doubled, to a total of 231.6 million prescriptions in 2012, according to Agency for Healthcare Research and Quality, which is part of Department of Health & Human Services. Furthermore, 10.7 percent of the U.S. population takes antidepressants, which is up from 6.7 percent in 2000.

“The greatest increase in the use of these medications has been among patients with less severe mental-health conditions,” says Ramin Mojtabai, who is an associate professor at John Hopkins Bloomberg School of Public Health and a co-author of two studies on overprescription.

Mojtabai says a driver of this problem is the use of depression screening by primary-care doctors, who account for nearly 4 out of 5 antidepressant prescriptions, Mojtabai’s research shows. A depression screening consists of questions that are meant to be used in routine doctor’s appointments to flag people who might have depression and should have a more exhaustive evaluation. Instead, the screens often are used improperly to diagnose depression, which can lead to unnecessary prescriptions, experts say. In fact, a study that was published in Journal of the American Board of Family Medicine in 2014 found that depression screening by a primary-care doctor doubled a patient’s chance of getting an improper depression diagnosis and tripled his/her chance of being prescribed antidepressants.

It isn’t just primary-care doctors who might diagnose depression incorrectly, however. A study that was published in American Journal of Psychiatry in 2013 found that trained mental-health professionals agreed only 25 percent of the time as to whether a particular patient met the criteria for depression. In other words, 75 percent of the time, the professionals who have the most training don’t agree on who should receive a depression diagnosis, which could lead to unnecessary antidepressant prescriptions.

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