Friday, April 12, 2013

Over Prescription of Antidepressants in America
            Over the years, physicians and psychiatrists have become more aware of many different diseases and their effects on the human mind and body. Along with these new discoveries have come many new drugs that claim to make the symptoms of a disease become less prominent in a patients everyday life and hopefully, eventually rid them of their symptoms and mental illness. Antidepressants are one of these new drugs. Antidepressants fight against the symptoms of depression which is becoming one of the most prominently diagnosed mental illnesses.
            Depression is defined as a, “a medical illness that causes a persistent feeling of sadness and loss of interest.” Along with this definition there are symptoms such as difficulty concentrating, fatigue, feeling of guilt, worthlessness, hopelessness, and being irritable. Many people of different ages and nationalities suffer from depression. People in their mid-30s are more likely to develop depression than any other age group. Caucasian middle and upper classes are also more likely to be taking antidepressants because they are able to afford a doctor’s visit as well as the prescription cost. Most of the lower class are unable to afford the medication and fees that come with going to the doctors, or urgent care facilities, thus making the upper and middle classes the biggest consumers of antidepressants.
 According to Centers for Disease Control and Prevention (CDC), “An estimated 1 in 10 U.S. adults report depression.” The CDC has estimated an increase in the use of antidepressants to nearly 400% from 1988 to 2011. This increase is due to more identifying symptoms of depression that doctors did not know about until later, as well as prescribing antidepressants for other mental illnesses as well not just for depression. The increase in prescription of antidepressants has also made it the second most prescribed drug in America, right after drugs to lower cholesterol National Public Radio says in an article titled “Antidepressants Use Climbs, As Primary Care Doctors Do the Prescribing.” The article then continues to say that an astonishing “Seven percent of all visits to a primary care doctor now involve a prescription for antidepressants.” Primary care physicians are not as qualified to be prescribing long-term antidepressants as a psychiatrist is because they are not as objective to the symptoms of severe depression compared to mild depression. Studies have shown that when given a placebo, 10% of participants had significantly lower symptoms of depression.
Many of the antidepressant drugs that doctors prescribe are meant for only severely depressed patients, but they are giving the medication to moderately depressed patients as well. This is where the question, “Are doctors over prescribing antidepressants,” comes into play.  According to the CDC, many primary care physicians are trying to avoid under prescribing the population. Under prescribing means when you leave a majority of patients out of a certain medication qualification. Many patients now days are self-assessing their symptoms and since depression is a very common mental illness with a vast spread of symptoms, patients are coming into medical offices demanding that they be put on these medications and reassuring the doctor that they are really depressed.  This type of behavior is what causes doctors to over prescribe antidepressant medication.
Another reason for the increase in antidepressant prescriptions is the fact that doctors are prescribing it for more than just depression. These medications can be ‘used’ to help with anxiety, insomnia, and any of the other symptoms that a patient might be having. I interviewed a friend of mine that had gone through a stage in her life where she needed professional help for a drug addiction she was suffering from. She said that the doctors and nurses at the rehabilitation facility she was at, “gave out antidepressants like they were candy.” Now many of the people in the facility with her were in fact depressed and needed help, but she personally was not depressed and was prescribed antidepressants because she had anxiety attacks. When she went home after being on this medication for two months and under the watchful eye of the psychiatrists and physicians at the rehabilitation facility, her mother noticed that she was acting very strange. She started to cry and become very violent when a plate of cookies was gone. She threw the plate across the room, making it shatter. As soon as her mom got her under control, she called a different psychiatrist to set up a meeting about switching her medication to something different than antidepressants because she was not depressed and just needed medication when she was having anxiety attacks which were happening often with the antidepressant medication she was on. Thankfully now my friend just takes medication when she is having an anxiety attack which is now very rare for her compared to when she was taking antidepressants.
On the opposite side of the argument, many doctors are claiming that they are over prescribing because of the different diseases and illnesses that the antidepressant drugs are able to ‘help’. According to a study performed by Queens College of the City University of New York there are quite a few different medical conditions that antidepressants can possibly better they include, but are not limited to anxiety, agitation, obsessive compulsive disorders (OCD), bed-wettingpost-traumatic stress disorder (PTSD).  All of these are very different illnesses but, seem to be controllable by the same medication. Since antidepressants can be used for so many different conditions, the study suggests that that is the reason for the spike in prescriptions filled over the last 4 years.
To combat the opposition, with the ability to cover such a wide range of illnesses, what are the symptoms, side effects, and long term effects on these patients who are taking antidepressants who are not depressed? In an online study of 856 participants, researchers were looking for side effects of taking antidepressants and which was the most common to least common symptoms. From the data collected, the most common side effects was sexual dysfunction with 41.9% followed by fatigue with 36.8%. the least experienced symptom was excessive sweating with 20% of participant selecting it from the list on the online test. These results were taken from people who were using antidepressant medication without being depressed. They had a wide variety of illnesses that they were taking the medication for.
Some of the major concerns about antidepressant are over prescription to patients who are not severely depressed and will be hooked on the medication for the rest of their lives, as well as the age ranges that are taking the medication. Teens and young adults have a higher likely hood of having serious side effects that could deter them in their everyday activities as well as make them even more depressed thus making them suicidal. The FDA had put in place many new rules and regulations for prescribing teens and young adults antidepressants because of a number of suicides and also because the percentage of those patients taking the medication compared to how many have or have thought about committing suicide has escalated to a very uncomfortably high number. A recent study was held by the American College of Neuropsychopharmacology or ACNP, looked at the data of 49 teenagers who had committed suicide and found that 24% had been prescribed antidepressants. With that number so very close to one fourth of the sample population, the FDA decided that they need to make harsher regulations on teens medications and what antidepressants are approved for them since many of the antidepressants are specialized for certain age groups.
With so many new medications coming out for antidepressants, doctors need to really look at all of the symptoms their patients have very closely to see if this patient is qualified for an antidepressant before prescribing them. These medications are not something to take lightly when you are being prescribed them. Doctors need to be making sure that patients are going to check up with a psychiatrist to see if they are actually making a difference or making the symptoms worse. Antidepressants are meant to work for severe depression, that is what they should be prescribed for.

Works Cited
"An Estimated 1 in 10 U.S. Adults Report Depression." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 31 Mar. 2011. Web. 08 Apr. 2013.
Hagell, Ann. "Increased Levels of Anxiety and Depression as Teenage Experience Changes over Time." Nuffield Foundation |. Nuffield Foundation, 14 Mar. 2012. Web. 08 Apr. 2013.
Kikuchi, Toshiaki, Takefumi Suzuki, Hiroyuki Uchida, Kiochiro Watanabe, and Masaru Mimura. "Coping Strategies For Antidepressant Side Effects: An Internet Survey."Journal of Affective Disorders 143.1-3 (2012): 89-94. Print.
 Rutherford, Bret R., Joel R. Sneed, and Steven P. "Does Differential Drop-Out Explain The Influence of Study Design On Antidepressant Response?" Journal of Affective Disorders 140.1 (2012): 57-65. Print
Staff, Mayo Clinic. "Definition." Mayo Clinic. Mayo Foundation for Medical Education and Research, 10 Feb. 2012. Web. 10 Apr. 2013.
Szalavitz, Maia, and Maia Szalavitz. "What Does a 400% Increase in Antidepressant Use Really Mean?" Time. Time, 20 Oct. 2011. Web. 08 Apr. 2013.