August 8, 2011

Depression – Under-diagnosed, Antidepressant Use Up

I am seeing a host of articles about diabetes and depression the last few weeks. While I am appreciative that diabetes and depression is receiving some of the attention that it needs, I am more than a little concerned about the article that appeared last week (August 4 and August 5). What is behind the study and what is the intention of psychiatrists?

Psychiatrists are concerned about the number of antidepressant prescriptions without a psychiatric diagnosis. The number of non-psychiatrist doctor visits where antidepressants were prescribed without a documented psychiatric diagnosis increased from 59.5% to 72.7% between 1996 and 2007, according to a new study published in Health Affairs.

Experts not affiliated with the study caution that there are many possible, and plausible, explanations for an increase, and that depression remains largely under-diagnosed and under-treated in the U.S. The study does include many conditions for which antidepressants are being prescribes such as diabetes, heart disease, and nonspecific pain symptoms.

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.
I am not surprised by this as it is what happened to me and I'll admit I rebelled, but my heart doctor was ready and willing to explain why he had prescribed them. With the number of people that have heart problems and diabetes that are at risk for depression, it was and is still a sound medical decision.

Now if the psychiatrists are going to insist on making a diagnosis before these medications are prescribed, I doubt many people will even go to that visit. I know that I would have passed. Depression was not something talked about in my family when I was growing up and one of my uncles firmly believed that these doctors were mislead and did not understand human nature.

If the psychiatric profession wants to continue to claim that depression is under- diagnosed and psychiatrists are under-utilized, then they have to do some serious image mending and change some ways that they do business. Mental health issues are finally coming out of the closet and being recognized as having some valid health concerns.

I will conclude by saying the psychiatric profession will do a lot of damage if they become contentious about non-psychiatrists prescribing antidepressants for conditions known to cause depression. True, not everyone with heart disease or diabetes suffers from depression or even 100 percent that have both chronic conditions. Still, I have to be concerned about psychiatrists becoming overly concerned and wanting a piece of the action when they are creating other problems.

Please watch for a coming blog tomorrow, titled “Access to Urgent Psychiatric Care Severely Limited”.

Read three articles about this here, here, and here.

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