New CDC Survey: 1 In 10 Americans Are Taking Antidepressants
You go in for a regular checkup. Your doctor asks you about certain symptoms, such as difficulty sleeping and/or feeling a little more down than usual. Next thing you know, you’re walking out of your doctor’s office with a prescription for an antidepressant.
“Often patients don’t come in saying, ‘I’m depressed,’ they come in with an incredible amount of different signs — headaches, trouble sleeping, for instance — but a deeper consultation will reveal that they are,” says Levy, an assistant professor of Medicine Mount Sinai School of Medicine. Now Garay sees Levy once every few weeks to check in, manage her symptoms, and discuss any issues, Levy says. According to Garay, the medication has “helped tremendously.”
Levy is one of many family doctors that are taking on the role of therapist with their patients.
According to new survey data from the Centers for Disease Control and Prevention, one in 10 Americans older than 12 are now taking antidepressants — a fourfold increase in the prevalence of antidepressant use since the late 1980s.
While antidepressant use is on the rise, it’s not always mental health professionals that are writing the scripts: less than one third of patients on antidepressants reported seeing a mental health professional within the past year.
The report, published Wednesday, draws on a survey of over 12,000 Americans over the age of 12. Women Garay’s age were the largest consumers of antidepressants: 23 percent of all women ages 40 to 59 reported taking antidepressants.
While the idea of primary doctor handing out antidepressants without a therapist’s consultation may seem alarming, many psychiatrists felt that screening for and treating depression in your doctor’s office was a necessary expansion of a PCP’s duties.
“The reality is that there are not enough mental health care providers around to treat all who need it,” says Dr. Gary Small, a psychiatrist and director of the UCLA Center on Aging. “Part of what we do as psychiatrists is teach doctors how to diagnose and treat depression so that a lot of depression can be handled in primary care.”
“It’s a required part of training in our specialty [to treat depression],” says Dr. Lee Green, professor of family medicine at the University of Michigan. “We refer patients with the most complex or treatment-resistant depression to psychiatrists for medication management, but that is only a minority of people with depression. Most patients can, and should, get their antidepressant prescription from their family doctor,” he says.
This doesn’t mean that seeing a mental health care worker isn’t necessary as well, however, Green says: “The concern I have with the low number of people seeing mental health professionals is that they’re not getting the psychotherapy, such as cognitive-behavioral therapy, that we know helps with depression. Personally, I don’t believe anyone should be treated with medication alone for depression.”
Dr. Sudeepta Varma, a psychiatrist at NYU Langone Medical Center and member of the American Psychiatric Association’s Public Affairs Committee for New York County, was also worried that patients might not be getting treated “optimally” with the best dosage of their meds if they never see a psychiatrist.
“People often come in to me having been prescribed antidepressants from their doctor and they’re on the lowest dose, wondering why it isn’t working for them,” she says. “Primary doctors should really work in consultation with a psychiatrist.”
Overall, doctors and mental health care professionals weren’t alarmed by the rising number of antidepressant prescriptions being written – to the contrary, some questioned whether more patients should be on medication.
The survey captured how many patients are on antidepressants, not necessarily how many patients are being treated for depression with antidepressants. Because antidepressants are also prescribed for anxiety, neurological pain, fibromyalgia, sleep problems, and menopausal hot flashes, some of those reporting being on antidepressants may have been medicated for those reasons, not for depression, says Dr. John Messmer, associate professor of Family and Community Medicine at Penn State College of Medicine.
“I think it’s a good thing that one in ten people in the U.S. are on antidepressants,” says Dr. Varma at NYU. “It’s really hard to convince people to be on medication — it’s not something that people do lightly. I think the fact that more people are on medication means that more people are becoming aware of the signs of depression and that there is less stigma about seeking help,” she says.
Government Task Force Recommends Fewer Pap Tests
(BlackDoctor.org) — The U.S. Preventive Services Task Force recently announced Tuesday that healthy women between the ages of 21 to 65 should only receive a Pap smear every three years. The federal panel, which is made up of experts in prevention and primary care, also did not support regular HPV screening for most women.
The experts warned that women are currently receiving too many Pap tests, saying the excessive screenings could cause more harm than good.
Instead of continuing to overtest, the task force said it would be better to reach out to those who have never been screened.
“There are a number of women who have never been screened, and that remains a challenge,” said Wanda Nicholson, one of the task force leaders and associate professor of obstetrics and gynecology at University of North Carolina at Chapel Hill Medical Center. “We need to keep those women at the top of our priority list and brainstorm for interventions for better access.”
Since the Pap smear became a regular part of women’s health, deaths from cervical cancer, which was once the No. 1 cancer killer among women, have dropped dramatically.
Cervical cancer screening is a success story, but the more testing you do, the more you run the risk of false positives, and potential harm over treatment,” said Nicholson . “Cervical biopsies are associated with pain and bleeding, they can cause short-term anxiety and worry about these subsequent procedures, and those treatments can [up the] risk of poor pregnancy outcomes, including preterm or low-birth weight babies.”
The new recommendations coincide with most of the task force’s 2003 recommendations. One difference: The older guidelines recommended screening begin within three years of becoming sexually active, or at the age of 21, whichever comes first. Now, doctors say there is no need to begin regular screening before the age of 21, whether a woman is sexually active or not.
Most experts agree with the new guidelines.
“Cervical cancer can be slow growing and there really is no need for annual testing,” said Dr. Ranit Mishori, assistant professor of family medicine at Georgetown University School of Medicine. “The hard part will be convincing patients, and particularly other doctors, that annual screens are not needed.”
The task force also discouraged regular Pap screening among teenagers, which is consistent with the recommendation from the American Academy of Pediatrics. Women older than 65 and those who have had their cervix removed are also discouraged from regular screenings.
“This latest USPSTF recommendation against HPV screening and for less frequent Pap testing further endorses that more is not always better when it comes to evidence-based preventive care,” said Dr. Mark Fendrick, a professor in the department of internal medicine at University of Michigan School of Public Health. “Excess testing comes at the expense of patient inconvenience [and] discomfort, unnecessary costs, as well as the mental anguish and potential side effects of false positive results.”
The American Cancer Society has the same recommendations for Pap testing, but has a different view for HPV testing.
“The main difference is that, dating back to 2002, the American Cancer Society and several other organizations recommended that HPV testing, along with the Pap test, is a good option for screening women starting at age 30,” said Debbie Saslow, the American Cancer Society’s director of breast and gynecologic cancer, who noted that several studies show the testing provides even further insight into cancer prevention.
Two years ago, the task force made new recommendations that low-risk women receive a mammogram every two years, rather than every year. Last week, the task force stirred up debate when the panel recommended against PSA tests for prostate screenings in healthy men, which many get yearly.
The task force also recommended against testing women younger than 30 for HPV. The doctors wrote there is insufficient evidence as to whether HPV testing, alone or in combination with Pap smears, adds to cervical cancer prevention. “HPV often clears on its own and is prevalent in younger patients,” said Mishori. “Not screening so frequently will give time for the infection to clear on its own, as it often does, and help ensure that too many unnecessary follow-ups and procedures will be avoided.”
It is important to note that a Pap smear does not mean annual screening. Experts noted that women often confuse the two, but women still need their annual pelvic and breast examinations.
“With all these different recommendations, we run the risk of having people to start missing their Paps and make it seem like they’re not important enough,” said Dr. Jacques Moritz, director of gynecology at St. Luke’s-Roosevelt in New York City. “You still need your annual exam. That means, you need your breast and pelvic exam, you just don’t need the actual swabbing of the cervix every year.”