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The Misprescription and Over-prescription of Antidepressants



Antidepressants are medications used to treat major depressive disorder and help relieve the symptoms such as low mood, anxiety, and worthlessness. Studies also proved that antidepressants can be used to treat other psychiatric conditions such as obsessive-compulsive disorder (OCD), post-traumatic disorder (PTSD) and anxiety disorder [6]. There are several different types of antidepressants, but these are commonly used in clinical treatments: selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs), noradrenaline and specific serotonergic antidepressants (NASSAs), and Tricyclic antidepressants (TCAs) [6].


Antidepressants were first developed in the 1950s, and their use has become increasingly more common in previous decades. According to the Centers for Disease Control and Prevention (CDC), antidepressant use increased from 1999 to 2014. Antidepressant use increased with age, from 3.4% among persons aged 12–19 using them, to 19.1% using them among persons aged 60 and over. Overall and in each age group, females were about twice as likely as males to take antidepressant medication [4].

In an age where medical technology is constantly being discovered and developed, we are told that we can overcome almost any pain with the use of drugs. Hence, people prefer choosing medications to suppress illnesses rather than experiencing discomfort and healing in a natural way. It is undeniable that prescriptions are helpful for numerous medical conditions, but we cannot ignore the fact that lots of prescriptions are given in the wrong context. The reliance of prescribers and patients on prescription drugs often leads physicians to overprescribe and misprescribe medications, a mistake that can have dangerous outcomes [2]. Likewise, the medications used for psychiatric conditions are also no exceptions with being misprescribed or over-prescribed worldwide, which makes the issue a heated topic in medicine and psychiatry today [1].


What are the consequences?


Over-prescription and misprescription drugs have become serious problems worldwide. The overuse of drugs such as opioids – narcotic painkillers – has become an increasing crisis. Between 1997 and 2016, the number of prescriptions filled in the US increased 85% – from 2.4 billion to 4.5 billion – even though the population increased by just 21%. Nearly half (49%) of adults take at least one prescription drug, 23% take three or more and about 12% take five or more, according to the latest data from the CDC. One in ten adults takes ten or more drugs, and the average adult takes four prescription medications, according to a Consumer Reports survey of 1,947 adults conducted in April [3]. Nowadays, antidepressants such as Celexa, Cymbalta, Lexapro, and Prozac are overprescribed for people who have mild depression, which is triggered by a life event such as a death in the family, job loss, divorce or breakup, an accident, trauma, or diagnosis with a serious health condition. Do people necessarily need a pill if these life events occur? For the vast majority of people who have mild depression, the symptoms relieve within a few weeks to a couple of months. [1,4].


When misprescribing and overprescribing occur, the negative effects range from simply not solving the health issue in question, to worsening the condition. Misuse or overuse of depressants brings adverse outcomes such as unpleasant side effects and toxicity. An over-prescription of anti-depressants, for example, could have reverse effects on a patient with depression. Misprescribing drugs could mean that the prescribed drug poses a health threat. A study involving 1,068,117 participants over 65 years old has concluded that during antidepressant recent use and past use, both stroke and mortality risks significantly increased compared to no antidepressant use [7]. Moreover, it is a huge financial burden on patients as well as taxpayers. This would also give chances for physicians and patients to cut back instead of finding an alternative treatment [1].


Why is it happening?

Psychotherapy is being discussed much more now, and this can help people with mental health illnesses. However, facts suggest that more than fifty percent of people with mental health problems are being treated solely with medications without any form of psychotherapy, and this trend is rising. This can be explained by the following reasons [8]:

· Drug industries spend a great amount of money annually to promote drugs, and also use loopholes in the law where there is no requirement for proving the existing drugs. These companies have also created a culture that supports the phrase “pill for every ill” and aggressively markets to both doctors and consumers, treating some “pre-” diseases with pills rather than lifestyle changes.

· Some doctors and researchers are lured by bonuses from drug companies and do not recognize that this is wrong. Beyond traditional advertising, promotion, and the influence of a certain type of drug, the bias of drug company-sponsored research (as published in medical journals) can also sway doctors toward more favorable impressions about drugs.


What can we do about it?

Many people have concluded it is time to start looking for safer and more effective treatments for depression. These alternative treatments can be used to treat depression and other mental illnesses instead of depending heavily on antidepressants [5]:

· Cognitive behavioral therapy (CBT), for example, seems to be getting more well-earned attention in the past few years. CBT can help patients understand their thoughts and behavior, and how these thoughts affect their daily lives. Experts also recommend that people with moderate to severe depression be treated with a combination of CBT and antidepressants.

· Interpersonal therapy (IPT) is another option for treating psychiatric disorders. This form of therapy mainly focuses on the patient’s relationship with others.

· Counseling is ideal for those who are generally healthy but need help coping with a current crisis such as anger, relationship issues, bereavement, redundancy, infertility, or the onset of a serious illness.

· Electroconvulsive therapy (ECT), or electric shock treatment, is sometimes used in the acute phase of psychotic disorders along with antidepressants. It is highly effective when other treatments do not work very well.

· For those who have suffered from depression or trauma but do not want to start taking medication, finding a licensed counselor could be a very good alternative option. Counseling can allow a person to work on emotional pain or trauma associated with their symptoms.

· Dietary changes could also be helpful. Eliminating stimulants such as alcoholic beverages sugar, refined carbs, toxic preservatives, and caffeine can help to prevent negative changes in mood.

· Exercise is also believed to be a great option against depression and depressive moods. Even mild physical activity boosts endorphins, which help us feel good.

· Local self-help groups are also something worth trying out. Meeting with like-minded people face-to-face can reduce feelings of isolation, provide a source of encouragement and understanding, and offer additional ways for you to get connected and provide support to others.

· Art and creative therapies have also proved to be effective in treating mental illnesses. These forms of therapy help patients express their feelings through things like painting, clay work, music, or drama. These activities can help the patients deal with their symptoms, especially if they find it difficult to talk about how they are feeling.


The misprescription and over-prescription of drugs have become more common in recent years with antidepressants being no exception. The consequences of them cannot be neglected because they are related to our health. Alternatively, we can try to use other ways to heal instead of solely relying on medications and not being blinded by the fancy commercials.



References:


1. Alduhishy M. The overprescription of antidepressants and its impact on the elderly in Australia. Trends Psychiatry Psychother. 2018;40(3):241-3.

2. ArtiModi. MEDICATION ERRORS AND PRESCRIPTIONS: A DANGEROUS TREND 2011 [Available from: https://www.medleague.com/medication-errors-and-prescriptions-a-dangerous-trend/.

3. Findlay S. Overprescribing: Do You Really Need to Take That Med? 2017 [Available from: https://medshadow.org/overprescribing-drugs/#.

4. Laura A. Pratt DJB, Qiuping Gu. Antidepressant Use Among Persons Aged 12 and Over: United States, 2011-2014 2017 [Available from: https://www.cdc.gov/nchs/products/databriefs/db283.htm.

5. NHS. Alternatives - Antidepressants 2021 [Available from: https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/antidepressants/alternatives/.

6. NHS. Overview - Antidepressants 2021 [Available from: https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/antidepressants/overview/.

7. Ön BI, Vidal X, Berger U, Sabaté M, Ballarín E, Maisterra O, et al. Antidepressant use and stroke or mortality risk in the elderly. European journal of neurology. 2022;29(2):469-77.

8. PUBLICCITIZEN. Misprescribing and Overprescribing of Drugs 2019 [Available from: https://www.citizen.org/article/misprescribing-and-overprescribing-of-drugs/#causes.


 

Contributors:

Writer: Yipaerguli Mohetaer

Editor: Kayjah Taylor

Health Scientist: Yipaerguli Mohetaer


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