TA, concerning off label indications, you stated: "I don't buy that. That's some 2 bit scientist unable to get his papers published so he talks about it in the throw away journals." This is not usually the case. A medication, such as Prozac, is originally approved by the FDA for certain indications--a very expensive process. As experience is gained with a new medication, more times than not, it is found useful and safe in other indications. Also more times than not, drug companies will not spend the money to have the FDA officially add the new indications; the process can be very expensive. With good supporting clinical data, including quality journal articles, physicians will prescribe off label. Many drugs of prescribed more for off label indications than for the original, FDA approved indications.
Also, Major Depression is not rare. At least 20% of the population will meet the diagnostic criteria for Major Depression at some point in their lives.
Concerning Prozac, psychiatrists, and indications, I don't believe psychiatrists are usually the over prescribing culprits. Psychiatrists are specialists in the area of psychopharmacology, and are generally careful to prescribe psychotropics only when indicated. It is usually physicians with less training in mental illness, who nevertheless try to treat it, who are the culprits. Psychiatrists often receive referrals from other MD's who have tried to treat a certain mental illness; their first job many times is to try to get them off the multiple psychotropics that someone else has erroneously put them on. It has been my experience that psychiatrists are very well trained and most are very careful with medications.
I do agree with your statement that psychiatrists are very frustrated with the control managed care has over their practices. More and more, they are not allowed to do psychotherapy. Most managed care companies will 'allow' psychiatrists to do only medical management. They want the less expensive social worker to do the psychotherapy. This is not to say that social workers are not good therapists, but psychiatrists are physicians trained to perform both medical management and psychotherapy, and both can often been done by the same person more efficiently. The ones that suffer the most under managed care's profit driven control are the patients. Fortunately, and it's about time, managed care in now under pressure to be more responsible for the patients needs.
Concerning indications for SSRI's (Prozac is in this class), they have proven to be very effective in Major Depression, some Anxiety Disorders, certain Eating Disorders, PMS, certain Impulse Control Disorders, Schizophrenia with Depression (in combination with an antipsychotic), Bipolar Disorder with Depression (in combination with a mood stabilizer. There are more, but this is long enough. All of these uses are supported by extensive clinical data and numerous quality journal articles.
Brad |
