Antidepressants Are Not Overprescribed for Mild Depression

Abstract

Objective Evaluate over-prescribing of antidepressant medication for minimal or mild depression. Method Electronic records data from four large healthcare systems identified outpatients aged 18 or older starting a new episode of antidepressant treatment with an ICD9 diagnosis of depressive disorder (296.2, 296.3, 311, or 300.4). PHQ9 depression severity scores at time of treatment initiation were used to examine the distribution of baseline severity and the association between baseline severity and patients' demographic and clinical characteristics. Results Of 19,751 adults beginning treatment in 2011, baseline PHQ9 scores were available for 7051. In those with a baseline score, 85% reported moderate or severe symptoms (PHQ9 score 10 or more), 12% reported mild symptoms (PHQ score 5 to 9), and 3% reported minimal symptoms (PHQ9 score less than 5). The proportion reporting minimal or mild symptoms when starting treatment increased with age, ranging from 11% in those under age 30 to 26% in those aged 65 and older. The proportion with minimal or mild symptoms was also moderately higher among patients living in wealthier neighborhoods and those treated by psychiatrists. Nevertheless, across all subgroups defined by sex, race/ethnicity, prescriber specialty, and treatment history, the proportions with minimal or mild symptoms did not exceed 18%. Secondary analyses, including weighting and subgroup analyses, found no evidence that estimates of baseline severity were biased by missing PHQ9 scores. Conclusions In these health systems, prescribing of antidepressant medication for minimal or mild depression is much less common than suggested by previous reports. Given that this practice may sometimes be clinically appropriate, our findings indicate that over-prescribing of antidepressants for mild depression is not a significant public health concern.

Antidepressant Prescribing in Primary Care to Older Adults Without Major Depression

“…The proportion of prescribing without a depression diagnosis was less than the 72.7% described by Mojtabai and Olfson in their NAMCS analysis (8), yet higher than the 26% found by Simon et al (13), which is likely a function of the respective data sources. NAMCS limits the number of visit diagnoses reported to just 3, so there may be visits for MDD occurring that do not get captured in NAMCS because MDD is in a lower position on the problem list.…”

“…Finally, a recent analysis of participants in the Baltimore Epidemiologic Catchment Area Study followed for 4 survey waves from 1981–2005 found that, among antidepressant users in the final wave, 69% did not currently and had never met criteria for MDD based on their survey assessments over the preceding 2 decades. Even a recent analysis arguing that antidepressant use without MDD is not a significant problem found that, among those ≥65 and newly-prescribed an antidepressant, 26% had symptoms below the threshold that suggests MDD (13). …”

The risk of depression, suicidal ideation and suicide attempt in patients with psoriasis, psoriatic arthritis or ankylosing spondylitis

“…Depression diagnoses were identified using ICD9‐CM visit diagnoses: 296.2X, 296.3X, 311, 309.0, 309.1 and 300.4. Recorded diagnoses of depression indicate clinically significant depressive symptoms as confirmed by PHQ9 . Suicidal ideation was identified using either PHQ9 questionnaires from the Epic/Clarity electronic health record (EHR) databases, where item 9 (thoughts of death or self‐harm) contained a score of 2 (‘more than half the days’) or 3 (‘nearly every day’); or ICD‐9‐CM diagnosis V62.84 (if not accompanied by an ICD9‐CM code indicating injury or poisoning).…”

Adjusting Antidepressant Quality Measures for Race and Ethnicity

“…Using methods previously described (5), health system records identified adult outpatients beginning a new episode of antidepressant treatment for a depressive disorder between 1/1/2010 and 12/31/2012. Self-reported race/ethnicity was identified from electronic medical records.…”