Antidepressants are not overprescribed for mild depression.

Area of Science:

• Psychiatry and Mental Health
• Clinical Pharmacology
• Health Services Research

Background:

• Overprescribing of antidepressants for minimal or mild depression is a concern.
• Previous reports suggest this practice is widespread.

Purpose of the Study:

• To evaluate the rate of antidepressant overprescribing for minimal or mild depression.
• To examine the association between baseline depression severity and patient characteristics.

Main Methods:

• Analysis of electronic health records from 4 large healthcare systems.
• Inclusion of outpatients aged 18+ starting new antidepressant treatment in 2011 with a diagnosis of depressive disorder.
• Utilized Patient Health Questionnaire-9 (PHQ-9) scores to assess baseline depression severity.

Main Results:

• Of 7,051 patients with baseline PHQ-9 scores, 85% had moderate to severe symptoms; only 15% had minimal or mild symptoms.
• The proportion of patients with minimal/mild symptoms increased with age, particularly in those 65+.
• Minimal or mild symptoms were more prevalent in patients in wealthier neighborhoods and those treated by psychiatrists, but did not exceed 18% in any subgroup.

Conclusions:

• Prescribing antidepressants for minimal or mild depression is less common than previously reported.
• The findings suggest that overprescribing for mild depression is not a significant public health concern.
• Clinical appropriateness of prescribing for mild depression should be considered on a case-by-case basis.