Anti-Depressants and Anti-Anxiety Medication - Coursework Example

Anti-Depressants and Anti-Anxiety Medication Anti-Depressants and Anti-Anxiety Medication According to Zito et al. (2002), Depression is an issue susceptible to youths. A longitudinal study at a university finds a growth in the number of students that seek help due to depression. American youth adopt antidepressants as a popular form of treatment while non-pharmaceutical alternatives are available. The author observes that dramatic increase of depression diagnoses and antidepressant corresponds with increasing visibility of direct advertising to consumers for antidepressants. Zito et al. (2002) confirm that antidepressants have heavy campaign and advertisement. Different authors conclude that direct to consumer advertising correlates with high purchase of antidepressants by youth in America. Mojtabai & Olfson (2011) has the concern of the expensive nature of antidepressant use together with presence of side effects to the user. The paper will investigate trends in the country concerning antidepressant prescriptions by non-psychiatrist. Mojtabai & Olfson compares the features of several groups of patients those that receive antidepressants without psychiatric diagnosis and those that receive antidepressants after a psychiatric diagnosis. In addition to that, Mojtabai & Olfson investigates patients from the same practices that do not receive antidepressant medication or psychiatric diagnosis. Next, the authors determine whether antidepressant prescribed for patients without psychiatric disorder relates to wide distribution of physicians. Lastly, the authors investigate clinical and policy implications in the observed patterns and trends. Mojtabai & Olfson (2011) cite that the use of antidepressant medications continues to grow since they are third most prescribed medications in America. The growth largely emanates from increase in antidepressant prescriptions without accompaniment psychiatric diagnosis. The authors’ analysis from 1996 to 2007 illustrates an increase of antidepressants prescribed with no psychiatric diagnoses that increase from 60 percent to 73 percent. Mojtabai & Olfson (2011) strive to find out some of the factors that contribute to this trend so that they can develop a policy response to counter the factors. Mojtabai & Olfson (2011) would like to implement broad reforms in the health care system to increase communication between primary care providers and mental health specialists. Currently, the antidepressant sales average $10 billion annually in United States. It is one of the expensive medication classes. The growth of the sales of antidepressants comes from non-professionals that give out prescriptions to providers. Mojtabai & Olfson observe unqualified psychiatrists write four in every five prescriptions. Mental health patients receive their medication from specialists and do not trouble over non-psychiatrist based prescriptions. The continual use of antidepressant medication raises questions concerning the appropriateness of their use. The antidepressants exhibit their use in limited psychiatric conditions such as chronic depression, anxiety disorders, few well-defined conditions, and major depressive disorder. A study by a private insured plan cites that close to 65 percent that use antidepressants did not receive diagnosis for the specific psychiatric disorder. Data Source Data in the study comes from National Ambulatory Medical Care Surveys. Mojtabai & Olfson determine whether prescription of antidepressant medication bases on provider’s use of drug names. National Ambulatory Medical Care Survey provides six medications for every visit. The authors analyze four categories of medical disorders that include asthma, hypertension, heart disease, and diabetes. Some of the patient source of payment includes Medicare, workers compensation, private insurance, no insurance, Medicaid, self-pay, and no charge. Mojtabai & Olfson focuses on the symptoms of psychological and mental disorders such as loss of sex drive, smoking problems, sleeping disturbances, psychosexual symptoms, impotence, nervousness, and anxiety. Some of the less psychological problems include abnormal sensations, feeling unwell, tiredness, and nonspecific pain. Other variables in use include the age of patient, gender, ethnicity, and race. Zito et al. (2002) informs that United States and New Zealand are the only countries that permit DTC ads. An average American has the exposure of 30 hours of seeing the ads in comparison with 15 minutes for consultancy. The role of the advertisement plays as a source of health information to warrant scholarly attention. During the college years, students experience intense pressure in the new tasks and responsibilities that correlate with mental distress. As a response to the mental issues, universities and colleges offer educational programs that can steer students toward appropriate treatments. The increased demand for mental health services leaves the counseling leaves the counseling centers with limitation in staff resulting to less therapy. The managed-care systems prefer to dispense antidepressant drugs by the primary physicians that have little psychiatric training in comparison to the expensive psychiatrist visits. Zito et al. (2002) describes the shift as an easy method to reduce costs with dire repercussions in future. Most of the college students fake illnesses or exaggerate symptoms of depression to acquire anti-depressant prescriptions. College students that take antidepressants claim they feel less stressed, well-rested, and more focused after consuming them. Students are unaware that heavy exposure to DTC antidepressants an easy solution to a complex problem. Zito et al. (2002) observes that DTC antidepressant ads portray the pill as a quick and easy solution .A comparative analysis of many years of ads on Prozac and Zoloft demonstrate using icons that depression is a minor imbalance that only needs a pill to resolve the issue. Zito et al. (2002) observes that antidepressant ads can help raise awareness of depression and direct the symptoms toward appropriate use while they also mislead the youth on the instant medication to eliminate an impending problem quickly. Zito et al (2002) finds a noteworthy media effects in the heuristic processing condition while in the systematic processing condition. In essence, teenagers without prior experience of depressive symptoms will process drug ad information in a heuristically way as those with prior experience will process antidepressant advertising due to high personal relevance. Mojtabai & Olfson use two types of logistic regression analyses to compare antidepressant visits that lack psychiatric diagnoses to antidepressant visits that include psychiatric diagnoses. Additionally, the authors perform aggregate analyses to assess practice-level trends in antidepressant visits without psychiatric diagnoses. Some of the drawbacks of the analysis include (1) provision of single patient visits. The data set does not have past treatments or psychiatric diagnoses. (2) The diagnoses recorded by clinicians is own judgment it is likely that experts would make different decisions.(3)The experimenters support the use of antidepressants to treat neuropathic pain syndromes that result from damage of the central nervous system. The authors classified antidepressants visits without a psychiatric disorder for visits that patients received prescriptions but no diagnoses with a psychiatric disorder. (4) National Ambulatory Medical Care Survey only concentrates on office-based care; it fails to include treatments in other places such as hospitals. Features of patients without psychiatric diagnoses compare antidepressant visits that include psychiatric diagnoses and antidepressant visits lack psychiatric diagnoses. Antidepressant visits lack psychiatric diagnosis rather than have indications of general medical illness. The experimenters compare antidepressant visits with psychiatric disorder; those without a diagnosis have a higher probability of heart disease and diabetes. Patients with psychiatric complaints are less likely to have antidepressant visits without a psychiatric diagnosis. The associations between antidepressant and problems such as abnormal sensations, smoking problems, nonspecific pain, tiredness, and premenstrual tension suggest that antidepressants treat medical complaints. Mojtabai & Olfson observe that antidepressant prescribing without psychiatric diagnoses continues to increase from the last 2 decades. The reason for this trend remains unclear. The absence of psychiatric diagnoses attributes to providers concealing patients psychiatric to protect them from stigma and adverse occupational or legal consequences. Providers have utile motivation to withhold psychiatric diagnoses deliberately. The temporal trends observed depict settlement or stigma policies overtime. Population surveys that involve structured psychiatric interviews tend to support the opinion that many patients that receive antidepressants have psychiatric diagnoses. Gabbard & Kay (2001) says mental and physical health research results from a paradigm shift from an outdated biomedical approach to bio psychosocial model that stresses on unique interactions among psychological, social, and biological factors. The bio psychosocial perspective is crucial to evaluate comorbidity of physical and health problems. The bio psychosocial model produces dramatic advance in health psychology. Research demonstrates that physical and psychological symptoms to increase correlation between psychological distress scales and physical symptoms checklists. Gabbard & Kay evaluates medical symptoms without identifying some of the pathology such as headache and irritable bowel syndrome. Pain is a pervasive medical problem since it affects an excess of 50 million Americans and costs more than $70 billion annually in health care costs and lost productivity. Patient’s experience pain and emotional suffering. Some of the costs include decreased productivity, increased health care utilization expenses, lost earnings, and disability benefits. One study calculates the annual cost of chronic low back pain between $20 billion and $60 billion to measure lost productivity and social security disability insurance benefits to calculate along the treatment costs. Mild psychiatric disorders in relation to patients with psychiatric disorders receive antidepressants to the patients without psychiatric diagnoses. Most of the patients with less prominent, anxiety disorders, and milder form of common mood fail to meet the criteria of psychiatric disorder. Some of the problems are not the main reason for the medical visit, while the patients’ complaints concerning them will prompt the provider to prescribe an antidepressant. The meta-analyses of randomized clinical trials that use placebos illustrate that the antidepressants do not have any therapeutic effect. The growth in prescriptions of antidepressants for the patients without clinical psychiatric diagnosis overlaps with changes in public attitudes toward psychiatric medications. Americans are receptive to antidepressant use for the less severe cases since they perceive psychiatric medications will provide benefits for personal and social well-being. According to Mojtabai & Olfson (2011), the lack of documentation in mental health treatment in the non-specialty settings can account for missing psychiatric diagnoses. If patients receive antidepressants for a long time, they tend to experience maintenance-phase treatment of depression and anxiety. Conversely, problems of transferring clinical information between mental health specialists and medical providers also contribute to missing psychiatric diagnoses. In other clinical contexts, issues of communication between general medical providers and specialists fail to include transfer information such as background information received from primary care providers. Policy implications do not have enough proof on the inappropriate use of antidepressants while the change in prescribing trend is worrying. The trend suggests that the primary care physicians tend to overestimate the effectiveness of antidepressant medications. The development of an appropriate policy response needs a deeper understanding on relative contributions that cause prescriptions of antidepressants without psychiatric diagnoses. Gabbard & Kay (2001) note that the cost and vulnerability of chronic pain is a major health problem in United Statesthe Joint Commission on Accreditation of Healthcare Organization develops new standards to evaluate pain. Comorbidity and pain related clinical research conducted tends to embrace biopsychosocial (BPS) perspective. The emergence of BPS perspective on mental health and pain disorder parallel the evolution of scientific thought in medicine. Biomedical reductionism in the area of physiology, anatomy, and biology starts during renaissance to increase scientific knowledge that body and mind work separately. That ideology dominates the field of medicine to affect the relationship between mental health and pain. The gate control theory by another researcher plays a momentous role on the psychosocial factors in the perception of pain. From that time, researchers view pain a complex set of phenomenon instead a simple, discrete, and specific entity. Gibbons et al. (2006) elucidate that suicide is leading cause of death for adolescents with depression having the greatest impact on the number of suicides. Each year, according to Gibbons more than 500,000 young people attempt suicide and almost 2000 of the children die as a result. To respond to the issues, physicians prescribe antidepressants to treat pediatric depression. Seven percent of Americans taking depressants are teenagers. Few clinical studies show antidepressants as ineffective for use in teens, in the meanwhile, psychiatrists are unaware of the information until recently since the Food and Drug Administration (FDA) approved label does not reflect ineffectiveness of antidepressants to treat them. Recent litigation that involves usage of antidepressants has selective serotonin uptake inhibitors (SSRIs). Gibbons et al. (2006) finds that FDA fails to address the side effects of SSRIs on teen population. Most of the teens that take antidepressants commit suicide before FDA took serious steps on the issue. Towards the end of 2004, FDA pronounced a prevalence of suicide cases on teen patients that take antidepressant medication and indicate on a high probability of the FDA to strengthen the warnings of SSRIs in future. In advent, FDA directed manufacturers to include a black box warning to all antidepressants detailing its susceptibility on teenagers that take antidepressant and need for close monitoring. Conversely, FDA developed Patient Medication Guide (Med Guide) to distribute together with antidepressants that will inform the risks associated with the consumption of antidepressants. In this development, FDA collaborates with manufactures among other stakeholders to ensure Unit of Use packaging. A patient can receive Med Guide with the antidepressant in the packaging created by drug manufacturer. FDA managed to list on its website different drugs that have new labels and contain Med Guide. The author believes that if FDA had taken a serious action earlier it could have mitigated numerous suicide cases due to antidepressants consumption. In future, FDA should consider of a more proactive approach to protect adolescents vulnerable in taking prescription medication. FDA require that all that conduct pediatric testing to improve on pediatric labeling to ensure to teenagers doctors no longer prescribe medication to children without considering the side effects. It is crucial to curb the off-label prescription that forces drug sponsors to conduct pediatric clinical trials. The comment analyzes FDA lax approach to regulate antidepressants for adolescents. It also suggests ways to improve FDA regulation of medication in pediatric populations by limiting off-label prescriptions. The argument is that even if off-label prescription does not regulate for adults, it should still regulate for the adolescents population since they are a distinct group. FDA strives to ensure that drugs taken by American citizens are effective and safe that strikes a balance between risks of a drug against the benefits of the drug to the population. The predecessor of FDA, the Pure Food, and Drug Act (PFDA) sought to prevent companies from manufacturing drugs that were ineffective. Pediatric Drug Development reckons that drugs safe for adults may not be safe for the pediatric populations since they are miniature adults. FDA attempts to address the unique issues presented by prescription drug use in children through laws and policy formulation. Gibbons et al. (2006) explains of in pinpointing antidepressants as the cause of suicides in the depressed individuals. This is because depressed individuals are likely to commit suicide regardless of whether they take antidepressants. The nature of depression makes it hard to determine whether someone will commit suicide due to the consumption of antidepressant or other causes. Suicidal ideation is prevalent among the entire teenage population rather than just depressed individuals. Prozac is the first approved SSRI and had a standard warning that did not refer to the causal role of the drugs in pediatric suicide. The emergence of recent scientific studies that identify SSRIs as the likely cause of suicides led to FDA to address the issue of pediatric use of antidepressants. For instance GlaxoSmithKline that manufactured Paxil submitted data to that suggested an increase in suicide and FDA recommended its harmfulness to children. The current regulation fails to strike a proper balance between protecting children from unethical research and the generation of enough information to make prescription of drugs safe for pediatric patients. Recently, the government has recognized that pediatric population is a unique group and is underway to create rules and regulations to address specific issues on the pediatric populations. The off-label prescription is a popular practice for the general population while it is common in pediatric population. The drawback of off-label prescriptions is that drug companies have little incentive to complete clinical trials with pediatric subjects. Some of the drugs do not have specific labels for children and physicians do not have any alternative than to prescribe medicine to children off-label. Individuals that favor off-label prescription to children claim that fewer drugs will be available to children once FDA limits off-label prescription use. FDA serves children by curbing off-label concerning the effects of drugs on pediatric patients other than allowing companies to reap benefits of pediatric patients without expending any resources. FDA attempts to protect children that take prescription drugs by increasing pediatric testing through voluntary incentive of BPCA and a mandatory testing of Pediatric Research Equity Act (PREA).the possibility of PREA curbing off-label prescription of new drugs require more clinical trials with pediatric subjects may fail to protect children soon enough. In conclusion, The Affordable Care Act can encourage greater collaboration among providers. Accountable organizations consist of new multidisciplinary networks that strive to share responsibility to provide comprehensive health care for all Medicare beneficiaries. The organization needs proper structures to improve the quality of mental health in the hospital settings. Different authors support a collaborative model that entails mental health specialists in the primary care management on major depressive disorder. The Health Information Technology for Economic and CUnical Health (HITEC) provides additional opportunities that will reduce fragmentation of health care delivery. Technology has numerous benefits such as increasing communication between mental health specialists and other providers. The non-specialists play a growing role in treatment of the common mental disorders and for that reason; they remain relevant for mental health policy. The wide misalignment between diagnosis and treatment suggests the need for a deeper inquiry and the use of options that appear fruitful. They can range from clinical efforts that will ensure patients receive appropriate treatments to implement broad reforms in the health care system to increase communication between specialists and non-specialists. References Barker, M. J., Greenwood, K. M., Jackson, M., & Crowe, S. F. (2004). Cognitive effects of long- term benzodiazepine use. CNS drugs, 18(1), 37-48. Gabbard, G. O., & Kay, J. (2001). The fate of integrated treatment: whatever happened to the biopsychosocial psychiatrist? American Journal of Psychiatry, 158(12), 1956-1963. Gibbons, R., Hur, K., Bhaumik, D., & Mann, J. (2006). The relationship between antidepressant prescription rates and rate of early adolescent suicide. American Journal of Psychiatry, 163(11), 1898-1904. Jureidini, J., & Tonkin, A. (2006). Overuse of antidepressant drugs for the treatment of depression. CNS drugs, 20(8), 623-632. Mojtabai, R., & Olfson, M. (2011). Proportion of antidepressants prescribed without a psychiatric diagnosis is growing. Health Affairs, 30(8), 1434-1442. Zito, J. M., Safer, D. J., Gardner, J. F., Soeken, K., Boles, M., & Lynch, F. (2002). Rising prevalence of antidepressants among US youths. Pediatrics, 109(5), 721-727. Read More