Subject:
Depression

Short Description:

Physicians May Overprescribe Antidepressants Based on Brief Depression Questionnaires

Background:

Brief depression screening questionnaires are popular, especially with primary care providers (PCPs). However, a new study suggests that PCPs who use these questionnaires might be prescribing antidepressants to patients who don’t need them.

This was a prospective study of patients at six primary care office locations in California. Each patient was administered the Patient Health Questionnaire-9 (PHQ-9) by the researchers immediately prior to a primary-care office visit. The PHQ-9 assesses how often respondents have experienced various symptoms (such as feeling down, sleep problems, thoughts of harming oneself) in the previous two weeks. Scores can range from 0 to 27. PHQ-9 results were not shared with the physicians.

For this study, the researchers focused on a specific population of 595 patients, those with a PHQ-9 score less than 10, since this group is considered to be at low risk for depression and poor candidates for taking antidepressants. In this group, most (545) did not complete a separate measure of depressive symptoms during their office visit. Very few of these patients were diagnosed with depression (10.5%), were recommended an antidepressant (1.6%), or were prescribed an antidepressant (3.8%). However, for those patients who were administered a brief depression symptom measure by their primary care provider, 20% were given a diagnosis of depression, 12% were recommended an antidepressant, and another 12% were prescribed an antidepressant.

Use of the screening measures, which was more common during office visits in HMO and Veterans Affairs settings, increased the likelihood that patients who were not likely to be depressed would receive depression treatment (odds ratio 3.2; 95% confidence interval 1.1-9.2). The study highlights the need for more research to determine the best way to use brief depression questionnaires in primary care practices, and to balance benefits and risks of treatment, including overdiagnosis of depression and the use of antidepressants (Jerant A et al, J Am Board Fam Med 2014;27(5);611–620).

TCPR’s Take: Most psychiatrists are aware that brief symptom measures are meant to be screening tools, not diagnostic instruments. Nevertheless, this study shows that in the primary care setting these questionnaires may provide the justification for a diagnosis of depression and the prescription of antidepressants to patients who are not clinically depressed. Without more evidence to support the use of screening instruments in primary care settings, this practice should be reconsidered.