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.