Needlessly Placed On Antidepressants?
There is a lot of media attention about a study claiming that Americans are on too many antidepressants and other psychotropic medications. As a family doctor in the field for almost 20 years I can conclusively respond to that with, “No shit!”. In the study, 60% of patients who didn’t meet criteria for depression were prescribed meds anyway. The bigger issue, to me, is why this is happening. Here are my thoughts:
- Many doctors are lazy and just want to throw pills at people instead of listening to patients, spending time with patients or sending patients to counseling.
- There is a lot of pressure from the idiots above who place quality indicators on such diagnoses as depression. They make sure every patient is asked about it. The reason is that previous evidence showed that depression was not diagnosed or treated enough. This lead to the pressure to treat and ta-da, you have this mess. it is very similar to the pain med problem we are also having.
- Diagnosing and treating psychiatric problems is the least scientific process we have and is more of an art than science. That is why studies on these medical problems are all over the place.
- Drug companies were allowed to use direct-to-consumer advertising and so more and more commercials started to proliferate, which convinced too many of the wrong people they have depression. And those people are hard to “unconvince”.
- There are NO psychiatrists to send to for a second opinion so it falls on the family doctor’s lap.
- Patients want the medications!! They want quick help. They don’t want to get messy with counseling. I offer EVERY patient I diagnose with depression counseling first and 99% say “I just want the medication”. Patients are as much to blame for this problem as the doctors. Don’t let any media story tell you otherwise. Feeling depressed is not the same thing has having depression!
- Americans have too much stuff and think they need/deserve more and get depressed when they don’t get it. We have lost perspective in life.
- Some Americans truly have it bad. Medications do not treat SLS (Shitty Life Syndrome).
The article above that I used as a reference is an example of the wrong people trying to give their opinions about this subject. They want federal investigations. They scream about all the people getting hurt from these meds. They miss my points completely.
Mild-moderate depression may do better with a pill that is not a medication (no worries about adverse affects). It is to bad that it is considered unethical to lie to our patients here in the U.S. I believe it is in Germany where the usage of placebo in mild depression is acceptable standard of care.
http://www.ncbi.nlm.nih.gov/pubmed/7945737
Or insurance will not cover counseling but will cover medication. Or insurance will only cover 2-5 counseling visits and that’s it, but they will cover medication and seeing the doctor. Or patients can’t find a counselor with whom they can connect that their insurance will cover. Or the patients is living paycheck to paycheck and lack paid time off and can’t take the time in the day to see a counselor. Or patients can’t find a counselor that they can afford.
I’m also concerned about the methods used in the study and how only major depression is worthy of treatment. The author use a lot of alarming language regarding anti-depressants which seems lumped in with anti-psychotics, as if these meds were the only ones that were problematic and makes me concerned about the inherent bias of the study itself. There’s no consideration or discussion given towards a risk-benefit analysis nor data showing with the advent of the SSRI’s suicide rates have decreased. Given the sorry state of mental health services, I can’t attribute that to better counseling.
Re: pts wanting only meds. I’ve had it happen the other way around – the physician doesn’t want to counsel the pt, they just want to throw meds at them.
As per my point #1 states. 🙂
“Feeling depressed is not the same thing has having depression!”
I think I am going to borrow this line.