A new study published in the American Journal of Geriatric Psychiatry reports that nearly one third of U.S. veterans who receive prescriptions for psychiatric medication from their doctors don’t actually have any diagnosed mental health problems. Medications that were commonly over-prescribed to older veterans, according to the results, were anti-depressants, sedatives, and mood stabilizers.
“Psychiatric medications can save lives, but they can also cause harm,” Ilse Wiechers, lead author of the study and a psychiatrist at Yale School of Medicine, told Reuters. “My work aims to ensure that older adults receive the right medicine for the right diagnosis in the safest way possible.”
The study found that veterans between the ages of 65 and 85 were the most likely to be prescribed psychiatric drugs without diagnoses – those over 65 were 44 percent more likely to experience this than those in their 40’s. Out of the total amount of veterans who were prescribed psychotropic medication in 2010, 30 percent did not have a psychiatric diagnosis.
Veterans with mental health issues has become a greater concern in light of veteran suicide rates, which have previously been reported to be as many as 22 per day. The number of veterans with mental illnesses has risen from 900,000 in 2006 to 1.2 million in 2010, according to U.S. Government Accountability Office.
But the issue of over-prescription isn't just happening among veterans. The American Psychological Association notes on its website that overall, many Americans may be over-prescribed psychiatric medications. “Writing a prescription to treat a mental health disorder is easy, but it may not always be the safest or most effective route for patients,” Brendan L. Smith writes on the APA website. He notes that many people might be receiving antidepressants from their primary care doctor instead of being evaluated by a specialist; and they might be experiencing a placebo effect rather than actually effective treatment. “If people knew more, I think they would be a little less likely to go down the medication path than the psychosocial treatment path,” Steven Hollon, a psychology professor at Vanderbilt University, said in the APA report.
The problem with over-prescribing is the risk of harmful side effects. The National Institute of Mental Health states that psychotropic medications can cause drowsiness, dizziness, rapid heartbeat, skin rashes and blurred vision. Some antipsychotic medications can spur people to gain weight and alter a person’s metabolism, as well as cause muscle spasms and tremors. Antidepressants, on the other hand, can cause headaches, nausea, sleeplessness, and sexual problems.
Though the study points to the fact that many veterans are being prescribed psychiatric drugs without a mental health diagnosis, the authors are aware that they can’t yet make clear-cut conclusions about the implications, as they don’t have answers as to why doctors are prescribing without diagnosing. “More research is needed before we can identify the most appropriate targets for change in clinical practice,” Wiechers told Reuters. “Our next steps are to work together with our non-psychiatry colleagues to better understand what is happening on the ground in their day-to-day clinical practice.”