Saturday, August 2, 2008

Anti-depressant prescriptions increase

According to US government, prescriptions for anti-depressants have increased over the last three years. The Agency for Healthcare Research and Quality spoke with people in-persona and over the phone who had received anti-depressant prescriptions. The interesting finding is WHO wrote the prescriptions.

29% of prescriptions were filled by psychiatrists (physicians who specialize in mental health disorders)
23% were from general practitioners (physicians who provide general care and are specialty trained)
21% came from family practitioners (physicians who provide primary care and completed a family medicine residency)
10% were from internal medicine specialists (physicians who focus on diseases in adults and have completed an internal medicine residency)


When I think about this report, there are a few things that run through my mind. First, it's a good example of how there is a growing trend in primary care physicians treating mental health disorders. I think it is good in some sense that people are going to their primary care physicians for all aspects of their health (just getting people to go is a good things), however, at the same time, many primary care, general/family practitioners do not have enough knowledge in mental health disorders to really know which medication to dispense as there are often a lot of factors involved. I'm sure there are many general/family practitioners who continue their medical education, but it's hard to say the exact number.

The other problem with primary care physicians treating mental illness is that many patients do not follow up with their physician to make sure they are not having side effects or that the medication adjustment is correct. Of course with personalized medicine, in the future, tests may be on the horizon to eliminate some of the guesswork of which medication to prescribe.

This report also reminds me about the few instances when I saw a nurse practitioner. Usually, I was going to some other ailment and the depression/eating disorder would come up as an aside. I'd tell her how I was feeling, and then she'd ask me what I'd like to try as if it was candy. She mentioned wellbutrin once, but I told her no since it was contraindicated with those who had bulimia. She did not know this fact and would have easily prescribed it to me had I not piped up at all. I had told her I liked to stay current on eating disorder research, and her reply was that I'd know better than she would about these things. While it's true I certainly like to think of myself as an informed consumer, I really thought the wellbutrin/bulimia contraindication was just a well known fact.

You may wonder why I didn't see a psychiatrist at the time. I probably fell into what other people have--not really finding the mental health side of me that important and seeing my regular, convenient doctor for another ailment with the happen to bring up the depression/eating disorder. Plus, I liked my nurse practitioner, I just know now not to go to her if I want to really talk mental health.

I think this is another reason why more general practitioners are filling prescriptions. Many people want the convenience of an all-in one stop shop. However, with mental health, I do think we all need to think about it more closely. That and general, family, and internal specialists continue their education in the world of medications. It's not a huge part of medical school, so it truly is important for them to stay on top of the research. In the end, it makes for better health of the patient and more knowledge for the physician.


ms.shoe said...

I found this article interesting, as my family Dr. specializes in depression and anxiety, both of which I have in conjunction with my AN.

I don't see a psychologist or psychiatrist, and do like the fact that he has this background so I can take care of everything in one shot. He has me follow up with him a couple weeks after starting a new med tosee how I am doing, and is very sensitive to noting my general demeanor and taking that into consideration as well.

I would not trust him to prescribe these meds if he just wrote me a script and sent me off on my merry way. His follow up ensures I am getting the best care possible.

And I know that not all PCP docs take that extra step, in which place it is not a healthy combination.

Tiptoe said...

Ms. Shoe, thanks for your comments. It is great that you have a Dr. who is also specialized in depression and anxiety and continues to follow up with you. I wish there were more family Drs. like that. Much luck to you.