just prescribed Effexor-really freaked to take-any thoughts?

[roster]

What if these are the people prescribing the antidepressants?

Depression in Residents, not Burnout, Poses Patient Safety Risk
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By John Gever, Staff Writer, MedPage Today
Published: February 08, 2008
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
BOSTON, Feb. 8 -- Burnout among medical residents does not put patients at risk of medication errors, but depression does, researchers here said.

Depressed pediatric residents made errors in ordering, transcribing, or administering medications 6.2 times more often than those who were not depressed (P<0.001), Amy Fahrenkopf, M.D., M.P.H., of Children's Hospital here, and colleagues reported online in BMJ.

That finding "indicates that mental health may be a more important contributor to patient safety than previously suspected," they wrote.

Error rates among residents deemed to be suffering burnout, however, were no different than among those who were not burned out (P=0.2), the researchers said.

Both depression and burnout have been found to be highly prevalent among residents worldwide, but few studies have measured their relation to patient safety, the researchers said.

Because the Institute of Medicine estimated in 2006 that more than 400,000 preventable adverse drug events occur in the United States annually, the researchers examined the relationship between depression and burnout and medication errors.

Among 123 pediatric residents studied prospectively at three hospitals -- one in Boston, one in Palo Alto, Calif., and one in Washington -- the researchers found 45 medication errors in the 6,078 orders written, for an error rate of 0.7%.

They found the following medication error rates per month:

* 1.55 (95% CI 0.57 to 4.22) among depressed residents
* 0.25 (95% CI 0.14 to 0.46) among those who were not depressed
* 0.45 (95% CI 0.20 to 0.98) among residents suffering from burnout
* 0.53 (95% CI 0.21 to 1.33) among those who were not burned out

Medication errors were identified by a special team of physicians and nurses on the basis of chart reviews.

Depression was assessed by the 10-question Harvard National Depression Screening Day Scale. Participants with scores higher than 9 were classed as depressed. Those with a previous diagnosis of depression but who were undergoing active treatment and scored no more than 9 were not classed as depressed.

The 22-item Maslach Burnout Inventory was used to evaluate burnout, defined as a syndrome of mental exhaustion and personal detachment resulting from long-term work-related stress.

Participants were considered burned out if they had combined scores of at least 27 for emotional exhaustion and at least 10 for depersonalization.

Of the 123 residents, 24 were depressed, all but one of whom also met criteria for burnout. Another 69 non-depressed residents were considered burned out, for a total of 92 with burnout.

Depressed residents were significantly more likely to report poor health, to be working in an impaired condition more than twice in the preceding month, and to have difficulty concentrating at work, the researchers said.

Burnout was significantly associated with concentration difficulties and with concern about being depressed.

Although rates of errors did not differ significantly between burned out and non-burned out residents (P=0.4), those classed as burned out were more likely to report having made a significant error in the past three months (29% versus 10% among those not burned out, P=0.05).

They also reported a higher mean number of errors over the previous month (2.3 versus 1.0, P=0.02), although counts of their medication errors as determined independently were not significantly more numerous.

The researchers were unable to determine whether the burned-out residents overestimated their errors or their non-burned-out colleagues underestimated theirs. Dr. Fahrenkopf and colleagues also said it was possible the burned-out residents were thinking of errors not related to medications.

They said the rate of depression they found was nearly twice what has been reported in the general population and near the midpoint in the range reported in other studies (7% to 56%).

"It seems that residency itself may be associated with the onset of depression in a sizeable number of residents," they suggested.

They also noted that other research has indicated that committing errors may itself lead to depression.

"Further efforts to study and improve the working conditions and mental health of doctors should be a priority," the researchers concluded.

Dr. Fahrenkopf and colleagues cited their focus on pediatric residents and lack of complete data on some of their participants as limitations to the study. They also said their data were collected before work-hour limits were imposed in the U.S., although they do not expect such limits would affect the link between depression and medical errors.

In addition, participants were aware that data would be collected on mental health status and medication errors. Half of those eligible to participate declined to do so.

In an accompanying editorial, James McLay, M.D., of the University of Aberdeen in Scotland, commented that the Boston study was interesting and had "face validity."

But he cautioned against interpreting the findings too broadly. He highlighted the 50% response rate and the relatively small number of medication errors found.

"It is therefore highly susceptible to selection bias, as shown by the low medication error rate of 0.7% reported for study participants," he wrote, noting it was less than the 1.2% rate for all residents in the participating hospitals during the study period.

"Furthermore, the study cannot determine the direction of any association between depression and medication errors, which is clearly important when designing potential interventions to reduce error rates," he wrote.

"Large, prospective, and appropriately designed studies are needed to clarify the roles of individual factors involved in error generation," Dr. McLay concluded.

[TossinNTurnin]

What if these are the people prescribing the antidepressants?

Yes, I would say that under/un-treated depression is quite costly in probably almost any field.

Which is why it's really not productive to just imply that people need to get off their pity pots.

[GrizzlyBear]

Spot on, TnT.

We need to be encouraging people to have their feelings diagnosed. Of course there's a problem with over or faulty diagnosis. This occurs in many fields, particularly when diagnosis requires a judgement to be made by a medical person. But this is simply cause for care, NOT cause for discouragement from seeking assistance.

I'm sure if we sought opinions from people on this forum, we would get heaps of examples of people who have been badly diagnosed - cpap pressures are just one example. But we need to be encouraging people to seek more information, and to seek assistance. The consequences of failing to do so could be catastrophic. In my case, it could very well have killed me - and, indeed, my shame at my illness almost did. The last thing I needed was somebody (albeit well meaning) discouraging me.

On the other hand, there will be others out there who have experience of bad diagnoses and awful drug outcomes. But that shouldn't discourage people from getting help, it should simply ensure that they seek second opinions if in any doubt, and get more good quality information from reputable websites, and watch themeselves and their loved ones carefully to adjudge the impact of any treatment.

Regards,

GrizzlyBear

[TossinNTurnin]

Spot on, TnT.

We need to be encouraging people to have their feelings diagnosed. Of course there's a problem with over or faulty diagnosis. This occurs in many fields, particularly when diagnosis requires a judgement to be made by a medical person. But this is simply cause for care, NOT cause for discouragement from seeking assistance.

I'm sure if we sought opinions from people on this forum, we would get heaps of examples of people who have been badly diagnosed - cpap pressures are just one example. But we need to be encouraging people to seek more information, and to seek assistance. The consequences of failing to do so could be catastrophic. In my case, it could very well have killed me - and, indeed, my shame at my illness almost did. The last thing I needed was somebody (albeit well meaning) discouraging me.

On the other hand, there will be others out there who have experience of bad diagnoses and awful drug outcomes. But that shouldn't discourage people from getting help, it should simply ensure that they seek second opinions if in any doubt, and get more good quality information from reputable websites, and watch themeselves and their loved ones carefully to adjudge the impact of any treatment.

Regards,

GrizzlyBear

Very well said Griz. I agree wholeheartedly!