Saturday, December 04, 2004

Antidepressant use soars...

Is anyone surprised by this news, from the Washington Post?
One in 10 American women takes an antidepressant drug such as Prozac, Paxil or Zoloft, and the use of such drugs by all adults has nearly tripled in the last decade, according to the latest figures on American health released yesterday by the federal government...
In 2002, more than one in three doctor's office visits by women involved a prescription for an antidepressant, said Amy Bernstein, project director for the report issued by the Center for Mental Health Services of the Centers for Disease Control and Prevention...
"Factors affecting the recent increase in utilization of medications include the growth of third-party insurance coverage for drugs, the availability of successful new drugs, marketing to physicians and increasingly directly to consumers, and clinical guidelines recommending increased utilization of medications for conditions ...," the report concluded.
Julie Zito, a pharmaco-epidemiologist at the University of Maryland at Baltimore, said it is difficult to characterize as good or bad the increased use of drugs without studies that ask how people are faring as a result.

Antidepressants are not just prescribed for depression. Various antidepressants are used in the treatment of panic disorder, obsessive-compulsive disorder, eating disorders, social phobias, attention deficit disorder, neuropathic pain syndromes, sleep disorders, agitated dementia syndromes, and for smoking cessation. I've met patients who were unable to take hormone therapy for menopausal symptoms, because of side effects. They were given Prozac instead. Add in the patients with disabling depressive symptoms, and it's no surprise that the use of antidepressants is soaring. There also seems to be an increase in patients receiving two or more antidepressants simultaneously.

There are patients who literally can't survive or function without these meds. But how many truly receive the intended benefits? Are the benefits worth the risks for these thousands of people? Have non-pharmacologic treatments been considered, or tried? The lack of data is stunning. In the clinic, we examine medication use, one patient at a time. Every day, I ask: Is this treatment helping you? Is the medicine worthwhile? What might we do differently?

update: Thanks to Dr. Emer for including this in Grand Rounds 12...but do I think that the surge in antidepressants is not spectacular? I think it is spectacular...but I'm not surprised by it, based on what I see every day. We'll find out whether the FDA's new warnings will stem the tide.
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