A new study has found that antidepressant drug use in the United States has gone up 75 percent, from 5.84 percent of the population to 10.12 percent.
The new study, published in the August issue of the Archives of General Psychiatry, looked at drug prescriptions from 1996 to 2005 in the U.S. Antidepressant use increased significantly across all age, gender and racial groups, except African Americans.
The data also shows a more than 10 percent decline in the use of psychotherapy amongst people treated with antidepressants, while at the same time showing a significant increase in the use of antipsychotic medications as a co-treatment to antidepressant therapy.
“Not only are more US residents being treated with antidepressants, but also those who are being treated are receiving more antidepressant prescriptions,” noted study authors Mark Olfson, MD, MPH and Steven Marcus, PhD.
The research also suggested that amongst people treated with antidepressants, fewer are seeing a psychologist or social worker in 2005 than they did in 1996. Overall, less than 32 percent of those people receiving an antidepressant medication visited a mental health professional (psychiatrist, psychological or social worker). Most received their psychiatric medication from a general practitioner.
“These trends vividly illustrate the extent to which antidepressant treatment has gained acceptance in the United States and the growing emphasis on pharmacologic rather than psychologic aspects of care,” the authors said.
Data were drawn from the household component of the 1996 and 2005 Medical Expenditure Panel Surveys (MEPSs). Both surveys were sponsored by the Agency for Healthcare Research and Quality to provide national estimates of the use, expenditures, and financing of health services. The MEPSs are conducted as national probability samples of the U.S. population and are designed to provide nationally representative estimates for comparisons over time.
Households selected for the 1996 and 2005 MEPS household surveys were interviewed in person 3 times to obtain health care utilization information for the survey calendar year. In both surveys, respondents were asked to record medical events as they occurred in a calendar or diary that was reviewed during each interview.
A sample of 21,571 participants provided data for the entire 1996 survey year. A sample of 32,320 participants provided data for the entire 2005 survey. For both surveys, a designated adult informant was queried about all related persons who lived in the household. The analysis was limited to participants aged 6 years or older during the 1996 (n=18,993) and 2005 (n=28,445) surveys.
The authors of the study discussed some possible hypotheses as to why antidepressant use has increased from 1996 to 2005. They suggested that it may be because major depressive disorder has become more common. Another reason they gave was that four new antidepressant medications were approved during the study period for the treatment of depressive and anxiety disorders (along with their associated direct-to-consumer advertising). And additional clinical guidelines were published during the study period extolling the use of antidepressants for a variety of additional mental health conditions.
But as more people are being prescribed antidepressants along with an atypical antipsychotic medication, the researchers expressed concern about the effectiveness and safety of these kinds of multiple prescriptions by a non-psychiatrist.
“Given that roughly 1 in 8 patients (13%) treated with antidepressants by nonpsychiatrist physicians are also treated with antipsychotics or mood stabilizers of proved or unproved efficacy,” the authors wrote, “the results highlight the importance of determining the safety and effectiveness of more complex pharmacologic regimens in general medical settings.”
The study also found no significant decline in the amount of prescriptions to children and adolescents, despite the October 2004 Food and Drug Administration “black box” warning added to antidepressants about their use in this population.
The authors noted that their data indicated “that the national rate of growth of antidepressant treatment in children and adolescents between 1996 and 2005 closely paralleled its growth in young adults, although the absolute rate remained considerably lower in youths than in young adults, and trends may change in more recent years.”
Both authors disclosed multiple financial relationships with various pharmaceutical companies, including those who make antidepressants. This study was supported by grant U18-HS016097 from the Agency for Healthcare Research and Quality and by the National Alliance for Research on Schizophrenia and Depression.
Source: Archives of General Psychiatry