Armed with statistics and studies, Peter Gove, innovation leader for health management at Green Shield Canada, spoke at the recent Mental Health Summit in Vancouver about high rates of diagnosis of depression and prescribing of antidepressants.
A study published in 2016 in the Journal of American Medical Association, for example, found less than 30 per cent of people treated for depression actually met any criteria for the condition and only 30 per cent of those who screened for depression were actually getting treatment, Gove told participants at the December event. “So it’s a weird picture where we’re treating a whole lot of people who may not be sick and not treating the people who are sick.”
The issue is important for plan sponsors and benefit managers given the cost of antidepressants to their drug portfolios. “We paid $45 million for claims for antidepressants. That’s higher than spending on specialty drugs and biologics,” said Gove.
In 2013, Green Shield looked at adherence rates for chronic disease medications and three years later examined patterns of prescribing and patterns of use. The research found only 12 to 15 per cent of people seemed to be taking medications in a way consistent with appropriate treatment guidelines. “The rest of the folks didn’t fill a second prescription or were on very low doses or took this medication only for very short durations,” said Gove. “We wondered if we were looking at people being treated for a major depression but who really have mild symptoms or didn’t want medication in the first place, because why would you not follow up if the medications were working for you and why would your prescribing physician not follow up?”
Population-based research shows rates of depression haven’t changed much over time, but in Canada and the United States, primary care practitioners’ diagnoses of depression and prescriptions for antidepressants have increased significantly. “One of the thoughts behind this expansion of who qualifies for diagnosis is to make treatment more widely available for those who need it,” said Gove. “But this requires a leap of faith that you can actually distinguish mild depression from general unhappiness and you can actually treat it with medications.”
Gove noted family physicians typically only have 10 minutes to assess a patient and the only option to help is often to write a prescription. But in British Columbia, all family physicians can refer patients with mood issues, stress or worry to Canadian Mental Health Association’s Bounce Back self-help program. “This may be a model for the rest of the country and the direction that benefit providers and sponsors may want to go,” said Gove.
While acknowledging that medication is useful for severe depression, Gove suggested people with milder symptoms may see better results from employee assistance programs, wellness and lifestyle changes focused on diet, exercise, sleep and stress reduction and greater access to psychologists and other counselling interventions.
“We want to nuance this thing and not catch everybody in the antidepressant net,” said Gove. “Let’s catch the right folks in the medical treatment net. Let’s spend our money wisely and let’s think about how we can redirect those resources to more effective programming.”