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‘Surveys’ triple iffy prescriptions for depression

New research links the use of short questionnaires to identify patients at risk for depression to possibly unnecessary prescriptions for antidepressants.

Known as “brief depression symptom measures,” the self-administered questionnaires are used in primary care settings to determine the frequency and severity of depression symptoms among patients.

Several questionnaires have been developed to help reduce untreated depression, a serious mental illness that can jeopardize relationships, employment, and quality of life and increase the risks of heart disease, drug abuse, and suicide.

The researchers were concerned that the questionnaires might lead to prescriptions for antidepressant medication being given to those who aren’t depressed.

Antidepressants are effective in treating moderate-to-severe depression but can have significant side effects, including sexual dysfunction, sedation, and anxiety. They also have to be taken over several months to be effective.

“It is important to treat depression, but equally important to make sure those who get treatment actually need it,” says Anthony Jerant, professor of family and community medicine at University of California, Davis, and lead author of the study.

Who gets a prescription?

The exploratory study included 595 patients of primary care offices affiliated with Kaiser Permanente in Sacramento, San Francisco VA Medical Center, Sutter Medical Group in Sacramento, UC Davis, UC San Francisco, and VA Northern California Healthcare System.

Patients selected for the study were considered at low risk for depression and therefore poor candidates for antidepressants, based on results of a widely employed brief screening tool known as the Patient Health Questionnaire – 9 (PHQ-9), which the research team administered.

The screener, which includes questions about changes in sleep, concentration, energy, and appetite, took place the same day the patients had appointments to see their primary care physicians, who were unaware their patients had completed the PHQ-9.

Based on a review of medical records, the patients were divided into two groups: those who were asked during their doctors’ office visits to complete brief depression symptom questionnaires, besides the one administered by the researchers, and those who were not.

The researchers compared the groups in terms of rates of depression diagnoses and prescriptions for antidepressants received from their physicians.

Of the 545 patients who did not complete brief depression questionnaires during their doctors’ office visits, 10.5 percent were diagnosed with depression and 3.8 percent were prescribed antidepressants.

Of the 50 patients who completed brief depression questionnaires during their doctors’ office visits, 20 percent were diagnosed with depression and 12 percent were prescribed antidepressants.

Beyond questionnaires

Jerant says the study highlights the need for research to determine the best ways to apply brief depression questionnaires in daily practice, as use of the screeners tripled the number of patients in the study who received prescriptions for depression treatment yet were not likely to be depressed.

Part of the problem could be in how questionnaire results are interpreted, Jerant says. Depression symptoms such as insomnia, fatigue, and poor concentration are associated with many health conditions.

“The questionnaires aren’t diagnostic in the sense that there’s a certain score that means the patient definitely does or does not have depression,” Jerant says.

“Formal interviews are required to help doctors decide whether a patient’s fatigue, for instance, is caused by depression. That fatigue could also be due to chronic lung or heart disease. It could also be due to an adjustment disorder that is usually transient and isn’t likely to respond to antidepressants.

“We need to give providers good guidance on how to use brief symptom measures in evaluating patients and making treatment decisions.”

The National Institute of Mental Health supported the study, which will appear in the Journal of the American Board of Family Medicine.

Source: UC Davis

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