This article is more than 5 years old. Information may no longer be current.

Antidepressant prescribing for mild depression less common than previously reported

Analysis of medical records from four large U.S. health care systems indicated prescription of antidepressants for mild depression was less common than suggested by previous reports.

“Use of antidepressants has increased dramatically over the past 20 years in the United States and in other higher-income countries. Approximately 10% of U.S. adults now fill one or more antidepressant prescriptions in any calendar year. Antidepressants prescribed by primary care physicians account for the majority of this increase,” Gregory E. Simon, MD, MPH, of the Group Health Research Institute, Seattle, and colleagues wrote. “Increasing rates of antidepressant treatment have raised concerns about overprescribing to patients with less severe depression. Community surveys suggest that the rates of antidepressant use may now exceed the prevalence of depression, especially among older adults.”

To evaluate overprescribing of antidepressants for minimal or mild depression, researchers assessed electronic records from Group Health Cooperative, HealthPartners, Kaiser Permanente Colorado and Kaiser Permanente Hawaii for individuals aged 18 years and older with an ICD-9 diagnosis of depressive disorder.

Baseline Patient Health Questionnaire-9 (PHQ-9) scores were available for 7,051 adults beginning treatment in 2011. Of these, 85% reported moderate or severe symptoms, 12% reported mild symptoms and 3% reported minimal symptoms.

The proportion of adults reporting minimal or mild symptoms when starting treatment increased with age, ranging from 11% among those aged younger than 65 years to 26% among those aged 65 years and older.

The proportion of adults reporting minimal or mild symptoms was moderately higher among those living in wealthier neighborhoods and those being treated by a psychiatrist.

Secondary analyses, including weighting and subgroup analyses, indicated no bias in baseline severity estimates due to missing PHQ-9 scores.

“Our data do not support the prior claim that the majority of patients treated with antidepressants have not experienced depression severe enough to warrant pharmacotherapy,” Simon and colleagues wrote. “The severity threshold for when to prescribe antidepressants is certainly not a bright line. Any attempt to evaluate the appropriateness of prescribing must allow for both the imperfection of standardized measures and the variability in individual patients’ clinical histories.” – by Amanda Oldt

Disclosure: Simon and Penfold report receiving salary support from research grants by Bristol-Myers Squibb and Otsuka Pharmaceuticals to Group Health Research Institute. Please see the full study for a list of all authors’ relevant financial disclosures.