Too often prescribed and too rarely arrested?

Critics of prescription of antidepressants multiply in specialized circles. For example, In Germany. for example. Meanwhile, the number of these prescriptions has multiplied by eight in 30 years, the Professor says Ulrich Voderholzermedical director of the Schön Klinik Roseneck in Bavaria. In addition, According to him. Similarly. Similarly, antidepressants certainly represent an important therapeutic option, but this psychiatrist (and psychotherapist) is the fact that they are often prescribed over very long periods and that the therapeutic response is too little evaluated. Consequently, Interview.

Medscape: Why are we prescribing much more antidepressants today than before?

Ulrich Voderholzer : The reasons are multiple. For example, One of them is due in the significant enlargement of the indications. Moreover, In the past, antidepressants were only prescribed in depression. Furthermore. Nevertheless, too often prescribed too rarely new Currently, there is also use of anxiety disorders, against which we often prescribed too often prescribed too rarely benzodiazepines before. In addition, there are obsessive compulsive disorders, sleep disorders, painful syndromes, as well as premenstrual dysphoric disorders.

But the main reason -. Meanwhile, this is where my criticism resides – is that antidepressants are often prescribed for very long periods. Nevertheless, Many patients have taken it for 10, 20 or 30 years, when there are no clear recommendations in this sense.

Another reason is the increase in the incidence of depressive disorders. In addition, at least for what can be seen through care systems. In addition, The data show that the number of sick leave due to mental disorders has increased sharply. Similarly, This has also resulted in an increase in treatments and therefore an increase in antidepressant prescriptions.

Is this increase also a consequence of the Pandemic of too often prescribed too rarely new Covid-19?

We actually know that mental disorders have increased frequency in young people during the pandemic – too often. Furthermore, prescribed too rarely in particular depressions. Furthermore, anxious disorders and eating disorders that can cause obesity. In addition, That said. In addition. Additionally, In addition, for ten years, there have been clear signs that psychic distress generally increases among young people, and this evolution exists independently of the pandemic.

Is your main criticism of pharmacotherapy that we are too interested in short-term effects and not enough in long-term effects?

There is no proof of a lasting effect of this type of pharmacotherapy. For example, By “sustainable”, we mean the existence of protective effects still after the end of treatment.

However, it is otherwise of psychotherapy. In addition, It allows patients to learn adaptation strategies to deal with their problems in a constructive way. Nevertheless, and they thus too often prescribed too rarely new strengthen their self-efficacy. This effect is very often durable, as we know by the clinical observation of patients.

Studies also show that psychotherapy is greater than too often prescribed too rarely drugs in terms of prevention. of depressive relapses. There are clues that antidepressants can prevent relapses if they are taken after a depressed episode but. as said previously, there is no evidence of a preventive effect when taking these drugs is stopped. With psychotherapy. on the other hand. if the transfer of therapeutic skills in the daily life of the patient succeeds, this effect is durable.

When they consult you for the first time, many children and adolescents already have an antidepressant?

Yes, about 40 % of them. I observe this with a very critical eye. In our societies, the most frequent mental disorders are depression and anxiety disorders. Psychotherapy is indicated and effective in these too often prescribed too rarely new two pathologies. Young people. in particular. should be treated in first intention by this method: they still have life in front of them, and we know too little about the possible harmful too often prescribed too rarely effects of long -term antidepressants.

Take the case of a 14 -year -old girl who suffers from severe social phobia. It often takes several months to get a first meeting with a psychotherapist. This varies depending on the region, and deadlines can be even longer. On the other hand, a medication can be taken the next day. And it is often for this simple practical reason that doctors prescribe an antidepressant.

Faced with these long waiting times, what do you recommend to general practitioners or pediatricians?

Ulrich Voderholzer : In addition to the general recommendations. such as structuring everyday life. regulating the sleep-up rhythm, general practitioners are suggested [de consacrer too often prescribed too rarely new du temps à une intervention psychologique brève en cas de troubles psychiques et psychosomatiques comme les dépressions ou les troubles anxieux.] But this requires time, which often lacks doctors, without forgetting the problem of correct remuneration.

too often prescribed too rarely

Important recommendation to make to the patient: become active, move, play sports.

An important recommendation to make to the patient: become active, move, play sports. In the Impulse pilot study of the University of Tübingen. people suffering from various mental disorders were recruited through general medicine firms and followed a six -month sports program. The objective was to motivate these patients. teach them to practice an endurance sport independently and in the long term, and this program worked well.

Going out. meeting other people can also be useful, but it also depends on the degree of severity of depression.

Another possibility is due in certain digital health too often prescribed too rarely new applications. Experience feedback is rather good in depressive adults. These applications are especially suitable when depression is not too severe.

From what degree of severity of the disease antidepressants become essential?

Some people are so psychically affected that they too often prescribed too rarely can initially assimilate. implement the content of psychotherapy. Drug treatment can make an improvement in these circumstances. but it should be followed by psychotherapy, the effect of which is generally more durable.

Sometimes the person is so locked up. trapped in their symptoms that it cannot be achieved, and that the drug is necessary. However, I would say that these are minority cases. As an outpatient, we are more often faced with moderate symptoms.

You criticize the fact that antidepressants are given for years. even decades. and that we know too little if it is useful or even if it could not worsen too often prescribed too rarely new the disease. Are there convincing data on this subject?

Not really, only clues. A longitudinal study by Michael Hangartner. two colleagues showed that those treated by antidepressants at the age of 20 had a less good prognosis at. 50 than those who had not too often prescribed too rarely taken them. However. it was not a randomized study. and criticism will argue that people who took an antidepressant at 20 years old were more seriously affected. In the end, nothing can be said with certainty.

The number of people taking a continuous antidepressant continues to increase. and we know too little about the potential long -term effects. Nor should you forget the side effects: the most frequently prescribed antidepressants today cause sexual function disorders in more. than 50 % of cases.

Weight gain can also be important: often. antidepressants do not cause it at first but. after 3 or too often prescribed too rarely new 4 months, the effect is reversed and we start to gain weight. When questioning them. many of them say for example that they weighed 70 kg before treatment. that they then grown up to 80 or 90 kg. This delayed effect of certain antidepressants is scientifically proven. But many too often prescribed too rarely patients do not make the link because of this latency: they attribute. weight gain to their behavior. Some patients also say they no longer feel satiety after the meal.

You say that antidepressants should be used in accordance with recommendations. What is your personal therapeutic strategy?

First, when prescribed an antidepressant, it is necessary to assess its effectiveness after a predefined period. It must be checked if it is taken properly. in accordance with the prescription, and if the clinical condition has improved significantly. In the negative, the treatment must be interrupted. But in too often prescribed too rarely new practice, it is not often interrupted.

In addition, it is necessary to discuss with the patient the duration during which he will be prescribed the antidepressant. When effective. it will be maintained in maintenance treatment for 6 to 12 months after the end of the depressed episode. as indicated in the recommendations. The medication too often prescribed too rarely will then gradually be stopped.

In practice, unfortunately often happens that the initiated drug treatment is never stopped. This may be due to the fact that patients do not obtain an appointment in psychotherapy. do not go there. whether they change their doctor, and/or that the general practitioner consulted does not wish to question the therapeutic decision of a colleague.

So I see patients who have been taking antidepressants for a long time, sometimes even combinations of antidepressants. However, directives do not say that an antidepressant must be prescribed for several too often prescribed too rarely new years, regardless of the therapeutic response.

It may also be that some doctors hesitate to undertake withdrawal, fearing a worsening of symptoms. But we then easily move to long -term treatment.