The authors concluded that the underlying reasons for the trend in antidepressant prescribing are not clear, but may include patient demand and clinicians’ lack of awareness about appropriate prescribing.
"Many people view psychiatric medications as enhancers of personal and social well-being, providing benefits that are well beyond these medications’ clinically approved uses," they wrote.
Policy Implications. "With nonspecialists playing a growing role in the pharmacological treatment of common mental disorders, practice patterns of these providers are becoming increasingly relevant for mental health policy," the authors conclude.
In order to make policy recommendations, however, the authors believe a "deeper inquiry" is needed. But policy options could "range from clinical efforts to ensure patients receive the most appropriate treatments to the implementation of broad reforms of the health care system that will increase communication between primary care providers and mental health specialists."
Prescribers need to be educated about the evidence for long-term use of antidepressants in various conditions to cut down on inappropriate use and also to reach the large number of patients who do have psychiatric disorders and yet are not being treated with medication. While the study found that medical practices are increasingly prescribing antidepressants, "paradoxically, a large proportion of patients with common mental disorders do not receive needed treatment because their primary care providers do not detect their conditions."
Furthermore, the authors suggested, it may be possible to reform insurance formularies to include tiers of cost sharing based on the severity of the mental condition and whether evidence supports treatment with medication. Cost sharing could be lower for certain uses and higher when the drugs are used for conditions for which there is little to no evidence of efficacy.
However, in their view, research is needed to show whether the additional costs and complexity of such changes in formularies would outweigh the benefits.
Health reform efforts will produce some advantages to monitoring antidepressant use, both by reduction of the fragmentation of care and through adoption of electronic health records.
This coverage is provided courtesy of "The Pink Sheet." This news organization and "The Pink Sheet" are owned by Elsevier.