To begin at the conclusion, my answer to my own question is: yes.
Those of us who conduct mood disorder research typically emphasize the underprescribing. Research I became aware of in the early 1980s found that only 20% to 25% of patients with MDD received minimally adequate treatment. NIMH and advocacy groups ramped up public awareness campaigns. Did they work? Many independent studies through at least last year have sadly come to the same conclusion found 30 years ago: Only a minority of MDD patients receive minimally adequate treatment—biological or psycho-social. Nothing has changed.
What’s with the overprescribed then? An article in press at the Journal of Clinical Psychiatry, which I edit, from Pagura et al, reports that in 2005 about 27 million Americans took antidepressants. But only 26.3% of them met diagnostic criteria for any psychiatric diagnosis at any time during their lives. This computes to roughly 5% of the citizenry taking an antidepressant without an obvious justification. Most likely, some are appropriately receiving prescriptions from primary care providers for pain and other reasonable indications. But others are probably getting their “scripts” from a harried clinician in lieu of a time-consuming assessment and possibly therapy or counseling. As a society, we should do better.
- Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry