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Are You Overprescribing These Common Meds?

Discussion in 'General Discussion' started by Mahmoud Abudeif, Jul 28, 2021.

  1. Mahmoud Abudeif

    Mahmoud Abudeif Golden Member

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    Alongside the still-increasing death toll and concerns over new variants and the phenomenon of long COVID, the coronavirus pandemic has left many other problems in its wake. Chief among them is a significant impact on global mental health, the extent of which has been reported by a growing body of research.

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    COVID-19 has kicked the use of antidepressants into high gear, and some question whether these drugs are being overprescribed.

    One of the immediate indicators of this parallel pandemic is an abrupt spike in prescriptions for antidepressants and anti-anxiety medications worldwide, which has led to a contentious debate about whether these drugs are overprescribed.

    Should doctors be wary of this trend? Or are we seeing an appropriate reaction to a new kind of health crisis stemming from COVID—the deterioration of mental health?

    Here’s what we know so far, according to studies and health experts.

    Mental health during COVID

    According to a study published in the DARU Journal of Pharmaceutical Sciences in June, shelter-in-place orders have resulted in long-term social isolation and “the loss of normal life,” which have led to rates of depression increasing 3-fold in the United States.

    Research published by the CDC in April supported those findings. CDC researchers partnered with the US Census Bureau to conduct a household survey and found that the percentage of adults who reported symptoms of anxiety or depression increased significantly from August 2020 to February 2021, from 36.4% to 41.5%. In January of this year, more than one in four adults experiencing these symptoms reported not receiving the counseling or therapy they felt they needed. The largest increases in symptom-reporting came from those aged 18-29.

    Researchers concluded that these increases were related to factors including fear and grief prompted by the spread of the virus and an increase in deaths, social restrictions, isolation, and unemployment.

    A spike in prescriptions

    Various studies have now documented a steep rise in prescriptions for antidepressants, anti-anxiety medications, and anti-insomnia medications. The aforementioned DARU study note there has been a 2- to 3-fold increase in the consumption of antidepressants over the last few years—and not just in the United States, but also Asia, Australia, and some European countries. The authors wrote that there was a “considerable rise” in these prescriptions between February-March 2020, and attribute this to the “increasing prevalence of depression among the general public which had almost doubled during the COVID-19 pandemic.”

    More specific figures can be found in research conducted by Express Scripts last year, which showed that the number of prescriptions filled per week for antidepressant, anti-anxiety, and anti-insomnia medications increased by 21% from mid-February to mid-March in the United States in 2020. Researchers noted that numbers peaked in the week ending March 15, which was when COVID-19 was officially declared a pandemic.

    Researchers found that the greatest increase was in prescriptions for anti-anxiety medication, which jumped by 34.1% from mid-February to mid-March 2020. The figures are significant, given that Express Scripts data indicated that anti-anxiety medication use had decreased by 12% between 2015-2019.

    According to an analysis published by the Wall Street Journal, prescriptions for anti-anxiety meds including clonazepam (Klonopin) and lorazepam (Ativan) rose by 10.2% from March 2019 to March 2020, from 8.8 million to 9.7 million. Similarly, prescriptions for certain antidepressants, including escitalopram (Lexapro) and fluoxetine (Prozac), rose 9.2% from 27.2 million to 29.7 million during the same period.

    This is corroborated by data published by SingleCare in December 2020, which indicated there was a 31% increase in fills for antidepressants in June 2020, compared to June 2019. Ramzi Yacoub, SingleCare’s chief pharmacy officer commented, “With the increased stress caused by job loss, self-isolation, and general anxiety, this increase in fills for antidepressants over the past year may well be due to the pandemic’s impact on mental health.”

    Concerns over prescriptions

    As noted in an MDLinx article, the increase in the use of prescribed antidepressants has prompted debate among experts over whether these medications are overprescribed, even prior to the surge in prescriptions seen during the pandemic.

    For starters, some question the long-term effectiveness of these medications. The authors of a review, published in the Journal of Clinical Medicine Research in 2019, found that relapse rates for patients with major depressive disorder who are prescribed antidepressants are “strikingly high,” sitting between 34-50%.

    There are also questions regarding over-prescription prior to the pandemic. According to the same review, only 15% of adults aged 65 or older who are prescribed antidepressants actually meet the full diagnostic criteria for major depressive disorder.

    According to the aforementioned MDLinx article, high rates of prescriptions increase the risk of adverse effects from these medications, which include decreased sexual function, type 2 diabetes, weight gain, low bone density, hypertension, and withdrawal symptoms if medication use is abruptly stopped.

    Likewise, research conducted by Syracuse University’s Lerner Center for Public Health Promotion, published in January, raised concerns over the increase in prescriptions of benzodiazepines, which are used to treat short-term anxiety.

    “The COVID-19 pandemic has inflamed pre-existing problems related to mental health, prescribing practices, and substance use,” the authors wrote, adding that prior to the pandemic, “public health officials and medical experts were already worried about the rising rates of prescriptions for benzodiazepines, such as Xanax (alprazolam).”

    Any extreme increases or decreases in prescribing these medications can lead to greater risks of overdose and dependence, a concern validated by CDC data, which shows that the number of overdose deaths involving benzodiazepines rose from 1,135 in 1999 to 11,537 in 2017. The number of overdose deaths involving antidepressants also increased over that period, from 1,749 to 5,269.

    While the data raises questions about prescription rates, authors of the Syracuse study point out that underprescribing also carries risks. Mental health treatment may be increasingly necessary, but it should involve symptom monitoring, ongoing therapy, and eventual prescription reductions to protect patients’ safety.

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