Antidepressant Use on the Rise as.....

Antidepressant Use on the Rise as Americans Become More Accepting of Psychiatric Medications

Caroline Cassels

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August 7, 2009 — A broad and marked increase in antidepressant use is occurring in the United States, with more and younger individuals receiving these medications, new research shows. However, treatment rates remain relatively low among racial and ethnic minorities. A second study suggests Americans have become much more accepting of psychiatric medications — a finding that may partially explain this increase.

In the first study, published in the August issue of the Archives of General Psychiatry, investigators found that the rate of antidepressant use in the United States has almost doubled among Americans older than 6 years — increasing from 5.84% in 1996 to 10.12% in 2005, or from an estimated 13.3 million to 27 million individuals.

Led by Mark Olfson, MD, MPH, from Columbia University Medical Center in New York City, and Steven C. Marcus, PhD, from the University of Pennsylvania in Philadelphia, the study showed there were significant increases in antidepressant use that were evident across all sociodemographic groups examined, except African Americans, who had comparatively low rates of use in both years (3.72% in 1996 and 4.51% in 2005). And they note that although antidepressant treatment increased for Hispanics, it also remained comparatively low in both years (3.72% in 1996 and 5.21% in 2005).

According to the study, antidepressants have recently become the most commonly prescribed class of medications in the United States.

"Several factors may have contributed to this trend, including a broadening in concepts of need for mental-health treatment, campaigns to promote mental healthcare, and growing public acceptance of mental-health treatments," the authors write.

Among antidepressant users, the percentage of individuals who were also prescribed antipsychotic medications increased during the study period — from 5.46% in 1996 to 8.86% in 2005. However, fewer patients received psychotherapy during that time period.

"Together with an increase in the number of antidepressant prescriptions per antidepressant user [an average of 5.6 vs 6.93, respectively, per year], these broad trends suggest that antidepressant treatment is occurring within a clinical context that places greater emphasis on pharmacologic rather than psychologic dimensions of care," the investigators write.

A second study, published in the August issue of Psychiatric Services, examined Americans' opinions about psychiatric medications, and found that they have become increasingly positive over the past decade.

Need for Greater Public Understanding

Although the increase in favorable attitudes is helpful in overcoming a common barrier to treatment, study author Ramin Mojtabai, MD, PhD, from Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, notes that the survey results point to a growing challenge for psychiatrists — that of "educating the public and providers to correctly identify conditions that merit the use of psychiatric medications and to distinguish these conditions from self-limited stresses of daily life that do not require medication treatment."

Dr. Mojtabai found that the percentage of individuals willing to take medication for specific psychiatric disorders increased between 1998 and 2006 for depression (from 41% to 49%) and for panic attacks (from 56% to 64%).

In addition, the percentage of individuals willing to take psychiatric medication for conditions not identified with a specific psychiatric disorder increased for trouble in personal life (from 23% to 29%) and to cope with life stress (from 36% to 47%).

"This finding calls for a more targeted and selective approach in public-information campaigns aimed at improving public understanding of the proper uses of psychiatric medications," writes Dr. Mojtabai.

The psychiatric medication questions were part of the US General Social Surveys, face-to-face, biennial, cross-sectional surveys of the general population of the United States conducted by the National Opinion Research Center at the University of Chicago.

Dr. Olfson reports receiving research support from AstraZeneca, PLC, and Ortho-McNeil Janssesn Scientific Affairs LLC. Dr. Mojtabai reports receiving research funding from Bristol-Myers Squibb Pharmaceuticals.