The number of Americans using antidepressants doubled in only a decade, while the number seeing psychiatrists continued to fall, a study shows.
About 10 percent of Americans — or 27 million people — were taking antidepressants in 2005, the last year for which data were available at the time the study was written. That's about twice the number in 1996, according to the study of nearly 50,000 children and adults in today's Archives of General Psychiatry. Yet the majority weren't being treated for depression. Half of those taking antidepressants used them for back pain, nerve pain, fatigue, sleep difficulties or other problems, the study says.
Among users of antidepressants, the percentage receiving psychotherapy fell from 31.5 percent to less than 20 percent, the study says. About 80 percent of patients were treated by doctors other than psychiatrists.
Patients today may be more likely to ask about antidepressant advertising, says study author Mark Olfson of Columbia University and the New York State Psychiatric Institute. During the study, spending on direct-to-consumer antidepressant ads increased from $32 million to $122 million.
Doctors today also are more comfortable prescribing antidepressants, partly because the newer drugs are safer and cause fewer serious side effects, says James Potash of Johns Hopkins Hospital in Baltimore, who wasn't involved in the study.
David Spiegel of Stanford University School of Medicine says he's glad to see more people getting treatment for depression, which causes more disability than any other medical condition.
But Olfson says his study shows that doctors need more training in mental health. And he says he's concerned about the decline in patients receiving psychotherapy. Patients who receive only medication may not get the help they need, he says.
Many patients are unable to see psychiatrists, however, because of insurance barriers. Many doctors no longer accept insurance because of low reimbursement rates for therapy, Spiegel says. The study ended before the passage of a 2008 law that requires employers with more than 50 workers to provide comparable benefits for mental and medical care.
Studies suggest doctors should be cautious about prescribing antidepressants to children. In 2004, the Food and Drug Administration issued a "black box" warning that the medications could increase the risk of suicidal thoughts in children. Use of antidepressants by children fell nearly 10 percent the next year, according to Olfson's 2008 study of the subject. Antidepressant use had been rising so quickly in the years before the warning, however, that the rate of use in 2005 was still higher than in 1996.