Could we be prescribing antidepressants to those who really need a hearing test?
A large-scale study published last April based on the National Health and Nutrition Examination Survey (NHANES) 2005-2010 found a significant correlation between hearing loss and depression, confirming some smaller studies and also anecdotal evidence.
What was most interesting was that the link was found only in certain populations.
There was no relationship between hearing loss and depression in people who were either culturally deaf or functionally deaf. There was no relationship in adults 70 and older who self-reported hearing loss. In other words, those who accepted their hearing loss did not experience greater levels of depression.
The study found a “significant” link in women over 70 with unreported hearing loss. (Hearing tests were given to all participants over 70.) The link was also strong in younger adults, ages 18 to 69. Women were also more likely to be depressed in the younger group. No hearing tests were given to the younger group, so no measure of depression with untreated hearing loss could be established. Women also take antidepressants at a much higher rate than men: 1 in 4 women vs. 1 in 7 men.
Now consider these factors: More than half of the 48 million Americans with hearing loss are under the age of 60. Not all of them have loss serious enough (as yet) to warrant hearing aids, but only a fraction of those who could benefit from hearing aids have one, so there is much untreated loss. Untreated hearing loss is strongly associated with cognitive decline, including dementia of all types, and it is often mistaken for dementia. Two-thirds of those 75 and over have hearing loss, much of it undiagnosed.
What if we did a hearing test before we prescribed those antidepressants?
Dr. Barbara Weinstein, founding executive director of the doctor of audiology program at the CUNY Graduate Center, maintains that acknowledging the relationship between hearing loss and depression is essential. “When doctors screen for depression using an aurally administered test,” she told me, “they rarely control for hearing loss. I am convinced that the validity of the scores are affected by not making sure patients can hear the questions.”
It is important not only for doctors to screen for hearing loss before diagnosing depression, Weinstein says, but for audiologists to also measure for depression — both before fitting hearing aids and after the user has begun to wear them regularly, to see if hearing aids help allay depression.
It’s an easy step for both doctor and audiologist, and could help cut the use of antidepressants where they are not warranted.
On Monday, the Federal Government Accountability Office released findings showing widespread use of psychiatric drugs by older Americans with dementia. The drugs included the “inappropriate” use of Abilify, Risperdal, Zyprexa and clozapine. Abilify, an antipsychotic intended for treatment of schizophrenia and bipolar disorder, as well as major depressive disorder in connection with other drugs, is the number 1 seller among all prescription drugs — not just antidepressants – in this country. Sales between April 2013 and March 2014 ($6.9 billion) amounted to more than all other antidepressants combined. That’s a lot of schizophrenic, bipolar and majorly depressed people. Clearly Abilify is being prescribed for more routine depression as well. Many dementias are clearly diagnosable, but some are not. Sometimes these turn out to be hearing loss or misplaced hearing aids. Are we treating these people with antipsychotics? Sounds more like a mental ward than an assisted living facility.