Use of Antidepressants is on the Rise

August 16, 2017

The CDC’s National Center for Health Statistics just put out a report about the increasing use of antidepressants.  As a psychologist (as opposed to a psychiatrist), I have mixed feelings about this.  On the one hand, there have been many studies that have demonstrated the superior or at least matched efficacy of psychotherapy over medication to treat depression and anxiety, so I find this trend concerning.  But on the other hand, when I recommend that some of my patients should consider consulting with their primary care provider or a psychiatrist and they express concerns about stigma, weakness or other reasons not to consider this treatment option, I attempt to reassure them that “antidepressants are one of the three most commonly used therapeutic drug classes in the United States” according to the report, and thus they should not feel self-conscious about taking such medications.

The report noted that there has been a progressive increase in antidepressant use since 1999, and that during the time of the study, nearly 13% of people over the age of 12 in the US have reported taking antidepressants in the past month.  Women take antidepressants at double the rate of men.  A quarter of those who reported using antidepressants have taken them for at least ten years.

It’s reassuring that those who need to take medication are in good company, but it is important to explore non-medical treatment of depression and anxiety, as the beneficial effects tend to be of a much longer-lasting duration.

Prevalence of Psychiatric Medication Use

December 13, 2016

medication

A recent research letter, published by JAMA, reported that one out of six American adults take at least one psychiatric medication.  As a clinical psychologist I understand the benefits of non-medical treatments for psychiatric illness, but that doesn’t mean I don’t appreciate appropriate use of psychiatric meds.  In fact, I refer a significant number of my patients to their primary care providers or to psychiatrists for medications, and I often make suggestions to the prescribing professionals about which medication I believe would work best for the referred patient.  Nearly every time I do this, however, I have a long discussion with my patient about what it means to be on a psychiatric medication, and what it doesn’t mean.  I almost always say something like, “several of your friends and several of your coworkers are on [psychiatric] meds… but they just haven’t told you,” in an effort to communicate how prevalent they are.  This letter drives that point home really nicely.

But what I really like about the letter is that it also talks about how some medications are not be prescribed appropriately.  Two classes of drugs that are most frequently mis-prescribed are benzodiazapines (e.g., Ativan, Xanax) and sedative/hypnotics (e.g., Ambien), which are supposed to be used short-term, not for months or years at a time.

Therapy is Better than Medication

February 10, 2016

The American College of Physicians has released a new clinical guideline on the treatment of depression in the Annals of Internal Medicine.  They suggested that psychotherapy is as effective for treating depression as antidepressants, and “given its relative lack of potential harms, should be strongly considered as the first-line treatment.” This is consistent with the American Psychiatric Association guidelines on major depressive disorder from 2010, which show therapy and antidepressant medications as being similarly effective.

The two issues that I, personally, have with this are: 1) that the guidelines specifically mention CBT and do not adequately discuss the benefits of other modalities of psychotherapy which may lead health care providers and patients to assume that CBT is the only mode of treatment that is so effective, and 2) the suggestion that psychotherapy has a “relative lack of potential harms.”  The word “relative” is key here: psychotherapy has significant fewer potential side effects than medication, but this does not mean that psychotherapy is side effect-free.  Therapy can be difficult for many patients at different times along the course of treatment and patients should be aware of this from the outset.

Primary Care Providers to Screen all Patients for Depression

January 27, 2016

The US Preventive Services Task Force (USPSTF) now officially recommends that primary care health clinicians screen all of their patients for depression. Though this is wonderful, this is very, very long overdue. The costs associated with depression and other mental health screen are insignificant relative to the potential gains of “catching” otherwise unrecognized suffering patients. Physicians and other front-line, primary care providers are offered screening guidelines by the AMA via this JAMA article.

Hopefully with more patients being routinely screened, including pregnant and post-partum women – – an often overlooked depressed population, more people will receive quality treatment consisting of psychotherapy and/or antidepressant medications.

Therapy, Medication or Both (or Neither)?

June 30, 2015

I stumbled upon this brief piece in the Huffington Post about when patients should consider doing psychotherapy, trying medication, doing both at the same time or not doing anything at all.  I liked this article because it was short and to the point while giving some nice examples behind the answer to the question: “it depends.”

As a psychologist I have many patients ask for medications and I have many patients refuse my suggestion that they consider medications.  I work with only a handful of psychiatrists who I trust, and one of the things that I really like about them is that they don’t always prescribe medication on the first visit and sometimes they don’t prescribe at all.  Now days many psychiatrists have defaulted to the role of “prescription mill” and they just see patients on the quarter hour, back to back, writing scripts as quickly as they can.  I feel fortunate that I have good relationships with some very thoughtful and knowledgeable psychiatrists.

I also feel fortunate that as a psychologist I have the luxury of time to get to really know my patients, develop a strong therapeutic relationship with them and then help them improve various aspects of their lives.  One of my favorite things to do in therapy is to review my clinical notes with a patient when we’re close to terminating treatment.  I have found that when people are feeling better they often forget just how bad things were when they first came to me.  When we read through the chart together they are reminded of the incredible progress they made.

Should you really be scared of antidepressants?

November 11, 2014

For the past decade some of the “newer” antidepressants have had “black box warnings” that caution about a risk of suicidal thoughts and behaviors in young adults and kids.  Though there has been controversy about this, the benefits and risks of these easily misinterpreted warnings is finally being looked at a bit more closely again (but not by the FDA yet).  See the TIME story or an article in the New England Journal of Medicine for more information.

Need an antidepressant? Try exercise!

September 10, 2014

Research has shown that when depressed people exercise 3-5 times per day for 45-60 minutes per session and achieve a heart rate of 50-85% of their max heart rate, the exercise is as effective, if not more effective, than medication. The Atlantic published a nice summary of the research and relevant literature.

Psychotherapy is as good as (or better than) medication

September 13, 2013

Yet another article was published recently that touted the positive effects of psychotherapy.  In this study the authors noted that psychotherapy was as effective as antidepressant medication at treating and preventing relapses of depressive episodes.  Of course the side effects from psychotherapy are much less than those from medication, which is nice.  But what made this article special was that it was published in JAMA Psychiatry.  Yup, one of the best professional publications for psychiatrists said that medications are not better that psychotherapy.  This is great for several reasons.  First and foremost, it’s a wonderful demonstration that the ever-increasingly medicalized field of psychiatry is willing to acknowledge the benefits of non-medical approaches.  Of course the content of the article is great too; there are many people who cannot tolerate psychiatric medications or simply do not want to use medicine to treat their psychological issues, and this (and many other) article(s) supports these individuals in not caving in to popping a pill to rid themselves of psychological pain.  Now, please don’t get me wrong… in no way am I opposed to appropriate use of psychiatric medication.  However, I am very frequently disappointed by medical professionals who prescribe antidepressants, sleep aids and antianxiety medications without considering empirically validated better options first or at least in conjunction with the medications.

Overuse of Antidepressants

January 23, 2013

Look around the room and you’re likely to find at least one person who is on an antidepressant medication now.  I just did a Google search for the “top prescription drugs” and according to Drugs.com, one antidepressant and another psychiatric medication are in the top ten ranking.  I often perform this search with my patients and there have been times when three or even four of the top ten prescribed drugs have been antidepressants and antianxiety medications.

In a recent piece in The Daily Telegraph from the UK, a general practitioner spoke out about the overuse of such medications, often without adequate discussion about the potential side effects of these drugs.  I couldn’t agree more.  Now with that said, I should be clear: I often recommend (sometimes quite strongly) that some of my patients consider taking antidepressant and other psychiatric medications.  We should not be polarized in our thinking about such treatment… these meds are often quite effective and when properly prescribed can have limited side effects (or we can even “leverage” the side effects to our advantage by prescribing antidepressants that have a more sedating side effect profile to patients with insomnia or meds with a more activating side effect profile to folks having trouble getting out of bed in the morning).  But such medications should not be used instead of other treatments such as psychotherapy; they are typically most effective when used in conjunction with talk therapy.  For more information see some of my other blog posts such as APA Promotes Psychotherapy and Use of Antidepressants.

APA Promotes Psychotherapy

October 17, 2012

The American Psychological Association (APA) recently launched a new awareness initiative about the benefits of psychotherapy.  There are a couple cute videos (below) that mock the pharmaceutical commercials that we see too often.  Though I very much appreciate this approach, I do not fully agree with the claim that psychotherapy has no negative side effects.  I can’t think of anything we can ingest, be exposed to or do that doesn’t have some side effects; for example everything we do comes at the expense of something else that we otherwise could have done.  I speak often about “compromise formation” with my patients and consulting clients, and with this concept, I believe firmly that psychotherapy does have side effects, but that they are almost always “worth it” from a cost-benefit analysis perspective.

Enjoy the videos…

 

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