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Depression fastest-growing diagnosis, report says
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 

"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.


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