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Depression fastest-growing diagnosis, report says
By GLORIA GALLOWAY
UPDATED AT 5:17 PM EST Friday, Mar. 26, 2004
Nearly 350,000 visits by young Canadians to family physicians last year resulted in recommendations that they take antidepressant drugs that are not clinically indicated for people under 20 and that research suggests may actually increase their likelihood of suicide.
The figures come from a report released yesterday by IMS Health that listed depression as the fastest-growing diagnosis at doctors' offices across Canada. Canadians with the illness received more than seven million recommendations from doctors in 2003 to treat the problem with drugs.
"We know that in 70 per cent [of the visits by young people with depression] an antidepressant was recommended," said Sue Cavallucci, a spokeswoman for IMS Health, which supplies pharmaceutical and health-care organizations with data on disease patterns and treatment trends.
Health Canada took the rare step in February of warning that antidepressants known as SSRIs (selective serotonin reuptake inhibitors), such as Prozac and Paxil, may increase the risk of suicide in children and teens. Medical professionals should "confirm that the benefits still outweigh the potential risk" before prescribing them, the department said.
According to the IMS Health study, people under 20 accounted for about 5 per cent of all doctors' visits that resulted in a diagnosis of depression in 2003. They were advised to take antidepressants less often than those in the older age groups, said Ms. Cavallucci, adding that it appears doctors are exercising more caution.
"In 1998, there were about 300,000 diagnoses made for depression among the zero-to-18 group . . . of which 69 per cent were treated" with
antidepressants, she said. "The number of treated visits went up to a high of 81 per cent in 2002 and back down to 70 per cent in 2003."
Jane Garland, a psychiatrist at the mood and anxiety disorders clinic at Children's Hospital in Vancouver, has said previously there is little
evidence that SSRIs are effective for young people.
Her profession has wanted these numbers for some time, she said in an e-mail yesterday.
"A recent study in [the] U.S. found that over 50 per cent of kids diagnosed with depression received medications, so our rate seems even higher," Dr. Garland said.
It is possible that the use of antidepressants is justified by the presence of other medical conditions -- for example, obsessive-compulsive disorder -- where there is more evidence that they work, Dr. Garland said.
"But I do hope [the young people with depression] are getting other treatments shown to be effective, such as cognitive-behavioural or
interpersonal psychotherapy" that are generally not covered by public health insurance, she said.
The IMS Health study found that 9.3 million visits to doctors' offices resulted in a diagnosis of depression. That is a 60-per-cent increase since
1995, and it is now the second-most-diagnosed ailment in Canada, after high blood pressure.
This doesn't mean that one-third of Canadians are clinically depressed, because a single patient could account for multiple visits, Ms. Cavallucci
"We're shocked by this every year because we see depression visits rising," she said. "It wasn't even in the top 10, 20 years ago."
All told, nearly 15.6 million SSRI prescriptions were written for Canadians in 2003 at a cost of $990-million.
John Service, the executive director of the Canadian Psychological Association, said the new figures are consistent with other recent studies.
"What's startling is the tremendous amount of depression that's obviously in
the public," Dr. Service said.
"It's really of concern."
It is also worrisome that drugs are being prescribed so often, he said.
"Because of the way the health system is structured, Canadians have access to therapeutics [medications], but they don't have much access to other kinds of therapy that we know works."
© 2004 Bell Globemedia Publishing Inc. All Rights Reserved.