Oct 4, 2011

Antidepressants prescribed without a psychiatric diagnosis in spite of Black Box warnings

WHAT IS THE POINT OF THIS ?

Why would psychotropic drugs, specifically, antidepressants be prescribed without a psychiatric diagnosis? The drugs have an FDA Black Box warning for suicide; the strongest warning issued by the FDA. A warning is obviously useless if it is not shared with patients or parents of children who are prescribed antidepressants. The warning is minimized, if shared at all with patients prescribed the drugs.

via Psychiatric News, an online publication of the American Psychiatric Association:

an excerpt from "Analysis Continues of Fallout from FDA's SSRI Warning"
“We observed a decline among children in the number of depression visits with an antidepressant prescribed after the FDA advisory, a trend that seemed to parallel an overall decrease in depression visits,” authors Shih-Yin Chen, Ph.D., and Sengwee Toh, Sc.D., wrote. “When we further assessed the trend in terms of proportion, the likelihood of prescribing an antidepressant among visits with a diagnosis of depression among children remained relatively stable at approximately 65 percent just before and after the advisory.... These findings suggest that the FDA advisory might have led to fewer numbers of depression visits overall and of depression visits with an antidepressant prescribed. But even with this decline, if children were actually diagnosed as having depression, they might not have been any less likely to have been prescribed an antidepressant after the advisory than they had been before.

Child psychiatrist and APA Treasurer David Fassler, M.D., said the study results are broadly consistent with several previous reports on the effects of the 2003 advisory. “The FDA hearings on SSRI antidepressants and the subsequent 'black box' warnings clearly had a significant impact on the recognition and treatment of depression in children and adolescents,” he told Psychiatric News. “Following the FDA's actions, young people were less likely to be diagnosed with depression, and many physicians became reluctant to prescribe SSRIs for pediatric patients.” read here

The September 2011 issue of Health Affairs had an article, "Proportion of antidepressants prescribed without a psychiatric diagnosis is growing"

"Over the past two decades, the use antidepressants between 1996 and 2007, the proportion of visits ant medications has grown to the point that they are now the third most commonly prescribed class of medications in the United States. Much of this growth has been driven by a substantial increase in antidepressant prescriptions by nonpsychiatrist providers without an accompanying psychiatric diagnosis. Our analysis found that between 1996 and 2007, the proportion of visits at which antidepressants were prescribed but no psychiatric diagnosis were noted increased from 59.5 % to 72.7 percent." read here

One of the things that really bothers me about mental health research is the overwhelming bias towards drugs being used to treat depression and every other psychiatric diagnosis. Psychiatric drugs used have some pretty serious risks, including dependence. This is troubling to me in that any ethical clinician is duty bound to share such risks with patients---but many do not.

I am not a doctor, but this does not sound science-based, so it cannot be Evidence-Based Medicine.