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Benedict Carey
About 1 in 6 U.S. adults reported taking at least one psychiatric drug, usually an antidepressant or an anti-anxiety medication, and most had been doing so for a year or more, according to a new analysis. The report is based on 2013 government survey data on some 242 million adults and provides the most fine-grained snapshot of prescription drug use for psychological and sleep problems to date.”I follow this area, so I knew the numbers would be high,” said Thomas J. Moore, a researcher at the Institute for Safe Medication Practices, a nonprofit in Alexandria, Virginia, and the lead author of the analysis, which was published Monday in JAMA Internal Medicine. “But in some populations, the rates are extraordinary.”
Moore and his co-author, Donald R. Mattison of Risk Sciences International in Ottawa, Ontario, combed household survey and insurance data compiled by the federal Agency for Healthcare Research and Quality. They found that 1 in 5 women had reported filling at least one prescription that year — about two times the number of men who had — and that whites were about twice as likely to have done so than blacks or Hispanics. Nearly 85 percent of those who had gotten at least one drug had filled multiple prescriptions for that drug over the course of the year studied, which the authors considered long-term use.
Dr. Mark Olfson, a professor of psychiatry at Columbia University, who was not involved in the study, said the new analysis provided a clear, detailed picture of current usage.
“It reflects a growing acceptance of and reliance on prescription medications” to manage common emotional problems, he said.
The most commonly used type of drug was an antidepressant like Zoloft and Celexa, followed by an anti-anxiety or sleeping pill like Xanax and Ambien. All of these drugs can have withdrawal effects, including panic attacks and sleep problems, for many people on them long term. The prescribing of most anti-anxiety pills is strongly regulated in this and other countries because the drugs can be habit forming.
“To discover that 8 in 10 adults are taking psychiatric drugs long term raises safety concerns, given that there’s reason to believe some of this continued use is due to dependence and withdrawal symptoms,” Moore said.
Usage rates were also higher with increased age, with 1 in 4 people of retirement age reporting at least one prescription. This is a growing concern among some doctors, as the incidence of diagnosable mental problems, with the exception of insomnia, tends to be much lower in elderly people than in young adults.
The increased rates in this group are most likely due in part to the fact that most elderly people get psychiatric drugs from their primary care doctors, who often prescribe for episodic conditions like mild depression and insomnia.
“Particularly for this group, we need to be mindful of the trade-offs in prescribing,” Olfson said. “These are not benign drugs.”
To view complete original study click here
Adult Utilization of Psychiatric Drugs and Differences by Sex, Age, and Race — (JAMA Internal Medicine)
Published online December 12, 2016
Limited public information is available about the extent of the use of psychiatric drugs among the US adult population. The Substance Abuse andMental Health Services Administration used the Survey onDrug Use and Health to estimate that 11.5% of adults reported taking prescription medication for “problems with emotions, nerves, or mental health” in 2011.1 (p92).
However, the survey excerpt does not provide information on which specific medications were more commonly used or on estimated duration of use. We sought to characterize adult use of psychiatric drugs in the United States using publicly available, nationally representative data and explore differences by sex, age, and race/ethnicity.
Methods
We used the 2013 Medical Expenditure Panel Survey2 to calculate percentages of the adult population aged 18 to 85 years using 3 classes of psychiatric drugs: (1)antidepressants; (2) anxiolytics,sedatives,andhypnotics;and(3)antipsychotics. Our psychiatric drug categories followed the survey’s Multum Lexicon therapeutic class scheme,3 except thatwe included all benzodiazepines
as anxiolytics, sedatives,andhypnotics, including those classified asanticonvulsants.Population percentages and 95%CIswere calculated from the survey’s multistage probability design, with 357 432 unweighted prescription records from a sample of 37 421 individuals. Long-term use was defined as 3 or more prescriptions filled in 2013 or a prescription started in 2011 or earlier. Logistic regressionwasused tocomputeodds ratios(ORs) to investigate differences by subcategories of sex, race/ethnicity, and age. The government survey datawere publicly available and de-identified, and therefore institutional review board approval was not required.
Results
Overall, 16.7%(95%CI, 15.9%-17.5%) of 242 million US adults reported filling 1 or more prescriptions for psychiatric drugs in 2013, including 12.0% (95% CI, 11.3%-12.7%) reporting antidepressants; 8.3% (95%CI, 7.7%-8.9%) filling prescriptions for anxiolytics, sedatives, and hypnotics; and 1.6%(95% CI, 1.4%-1.8%) taking antipsychotics. Table 1 highlights differences by sex, age, and race/ethnicity. Large differences were found in race/ethnicity,with 20.8%of white adults reporting use vs 8.7%of Hispanic adults (OR, 3.1; 95%CI, 2.7-3.5).
Rates for blacks and Asian adults were also lower than those for white adults, but not statistically significantly different from Hispanic
adults. Use of psychiatric drugs also increased with age with 25.1%of adults aged 60 to 85 years compared with 9.0% of those aged 18 to 39 years (OR, 3.4; 95%CI 3.0-3.9).Women were more likely than men to report taking psychiatric drugs (OR, 2.0; 95% CI, 1.8-2.2). For antipsychotics, there was little variation in exposure by any demographic subgroup. The 10 most frequently used sychiatric drugs are shown in Table 2.
Most psychiatric drug use reported by adults was long term, with 84.3%(95%CI, 82.9%-85.7%) having filled 3 or more prescriptions
in 2013 or indicating that they had started taking the drug during 2011 or earlier. Differences in long-term use among the 3 drug classes were small. The long-term users filled a mean (SE) of9.8(0.19) prescriptions for psychiatric drugs during 2013.
Discussion
These data show 1 of 6 US adults reported taking psychiatric drugs at least once during 2013, but with 2- to 3-fold differences by race/ethnicity, age, and sex. Moreover, use may have been underestimated because prescriptions were self- reported, and our estimates of long-term use were limited to a single survey year.
| Table 1. US Adult Population Exposed to Psychiatric Drugsa | ||||
| Use of Psychiatric Drug by Class, % (95% CI) | ||||
| Demographic
Characteristic |
Anyb |
Antidepressants |
Anxiolytics, Sedatives,
and Hypnotics |
Antipsychotics |
| All | 16.7 (15.9-17.5) | 12.0 (11.3-12.7) | 8.3 (7.7-8.9) | 1.6 (1.4-1.8)
|
| Sex | ||||
| Male | 11.9 (11.1-12.7) | 7.7 (7.0-8.4) | 6.1 (5.4-6.8) | 1.5 (1.2-1.8) |
| Female | 21.2 (20.0-22.4) | 15.9 (14.8-17.0) | 10.3 (9.5-11.1) | 1.7 (1.4-2.0) |
| Age, y | ||||
| 18-39 | 9.0 (8.0-10.0) | 6.6 (5.8-7.4) | 4.0 (3.4-4.6) | 1.3 (1.0-1.6) |
| 40-59 | 18.8 (17.6-20.0) | 13.7 (12.7-14.7) | 9.2 (8.2-10.2) | 2.1 (1.7-2.4) |
| 60-85 | 25.1 (23.5-26.7) | 17.3 (15.8-18.8) | 13.2 (11.9-14.5) | 1.4 (1.1-1.8) |
| Race/ethnicity | ||||
| Whitec | 20.8 (19.8-21.8) | 15.0 (14.1-15.9) | 10.1 (9.3-10.9) | 1.7 (1.4-1.9) |
| Black | 9.7 (8.8-10.6) | 6.2 (5.4-7.0) | 4.7 (4.1-5.3) | 1.9 (1.4-2.4) |
| Hispanic | 8.7 (7.9-9.5) | 5.7 (5.0-6.4) | 5.0 (4.4-5.6) | 1.3 (1.0-1.7) |
| Asian | 4.8 (3.6-6.0) | 3.1 (2.1-4.1) | 2.3 (1.6-3.0) | 0.7 (0.2-1.2) |
a Includes 40.4 million adults aged 18 to 85 years who reported exposure in the 2013 Medical Expenditure Panel Survey.
b Persons may be exposed to multiple psychiatric drug classes.
c Includes races/ethnicities designated “other.”
| Table 2. Persons Reporting Prescriptions for 10 Leading Psychiatric Drugs a
|
||||
|
Rank
|
Drug Name
(Brand Name) |
Mechanism
of Action |
Reported Use, No. of Persons
(in Thousands) |
Prescriptions per Person,
No. |
| 1 | Sertraline hydrochlolride (Zoloft) | SSRI antidepressant | 6,223 | 5.8 |
| 2 | Citalopram hydrobromide (Celexa) | SSRI antidepressant | 5,403 | 5.6 |
| 3 | Alprazolam (Xanax) | Benzodiazepine | 5,259 | 4.9 |
| 4 | Zolpidem tartrate (Ambien) | Hypnotic | 4,865 | 5.0 |
| 5 | Fluoxetine hydrochloride (Prozac) | SSRI antidepressant | 4,259 | 5.5 |
| 6 | Trazodone hydrochloride (Desyrel) | SARI antidepressant | 4,166 | 5.6 |
| 7 | Clonazepam (Klonopin) | Benzodiazepine | 3,273 | 6.3 |
| 8 | Lorazepam (Ativan) | Benzodiazepine | 3,165 | 4.9 |
| 9 | Escitalopram oxalate (Lexapro) | SSRI antidepressant | 3,065 | 5.5 |
| 10 | Duloxetine hydrochloride (Cymbalta) | SNRI antidepressant | 2,709 | 5.7 |
Abbreviations:
SARI, serotonin antagonist reputake inhibitor;
SNRI, serotonin norepinephrine reuptake inhibitor;
SSRI, selective serotonin reuptake inhibitor.
a Includes 40.4 million adults aged 18 to 85 years who reported exposure in the 2013 Medical Expenditure Panel Survey.
Among adults reporting taking psychiatric drugs, more than 8 of 10 reported long-term use. Prescribing information for the leading antidepressants includes limited information about appropriate duration of treatment. However, benzodiazepines have warnings about drug dependence, tolerance, withdrawal, and rebound symptoms.4 In a previous study5, we found most patients were long-term users of the hypnotic zopidem tartrate despite recommendations for short-term use, and many were combining it with other central nervous system depressants despite warnings.
Safe use of psychiatric drugs could be improved by increasing emphasis on prescribing these agents at the lowest effective dose and systematically reassessing the need for continued use.
Thomas J.Moore, AB
Donald R.Mattison, MD, MS
Author Affiliations: Institute for Safe Medication Practices, Alexandria