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National Trends in Psychotropic Medication Polypharmacy in Office-Based Psychiatry

 

Ramin Mojtabai, MD, PhD, MPH; Mark Olfson, MD, MPH

 

Arch Gen Psychiatry. 2010;67(1):26-36.

 

Free full pdf download at http://archpsyc.ama-assn.org/cgi/reprint/67/1/26

 

ABSTRACT

 

Context Psychotropic medication polypharmacy is common in psychiatric outpatient settings and, in some patient groups, may have increased in recent years.

 

Objective To examine patterns and recent trends in psychotropic polypharmacy among visits to office-based psychiatrists.

 

Design Annual data from the 1996-2006 cross-sectional National Ambulatory Medical Care Surveys were analyzed to examine patterns and trends in psychotropic polypharmacy within nationally representative samples of 13 079 visits to office-based psychiatrists.

 

Setting Office-based psychiatry practices in the United States.

 

Participants Outpatients with mental disorder diagnoses visiting office-based psychiatrists.

 

Main Outcome Measure Number of medications prescribed in each visit and specific medication combinations.

 

Results There was an increase in the number of psychotropic medications prescribed across years; visits with 2 or more medications increased from 42.6% in 1996-1997 to 59.8% in 2005-2006; visits with 3 or more medications increased from 16.9% to 33.2% (both P < .001). The median number of medications prescribed in each visit increased from 1 in 1996-1997 to 2 in 2005-2006 (mean increase: 40.1%). The increasing trend of psychotropic polypharmacy was mostly similar across visits by different patient groups and persisted after controlling for background characteristics. Prescription for 2 or more antidepressants, antipsychotics, sedative-hypnotics, and antidepressant-antipsychotic combinations, but not other combinations, significantly increased across survey years. There was no increase in prescription of mood stabilizer combinations. In multivariate analyses, the odds of receiving 2 or more antidepressants were significantly associated with a diagnosis of major depression (odds ratio [OR], 3.44; 99% confidence interval [CI], 2.58-4.58); 2 or more antipsychotics, with schizophrenia (OR, 6.75; 99% CI, 3.52-12.92); 2 or more mood stabilizers, with bipolar disorder (OR, 15.46; 99% CI, 6.77-35.31); and 2 or more sedative-hypnotics, with anxiety disorders (OR, 2.13; 99% CI, 1.41-3.22).

 

Conclusions There has been a recent significant increase in polypharmacy involving antidepressant and antipsychotic medications. While some of these combinations are supported by clinical trials, many are of unproven efficacy. These trends put patients at increased risk of drug-drug interactions with uncertain gains for quality of care and clinical outcomes.

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PhilRS

Antidepressant Use in the Absence of Common Mental Disorders in the General Population

 

Jina Pagura, BSc (Hons), MA; Laurence Y. Katz, MD, FRCPC; Ramin Mojtabai, MD, PhD, MPH; Benjamin G. Druss, MD, MPH; Brian Cox, PhD; and Jitender Sareen, MD, FRCPC

 

J Clin Psychiatry 2011;72(4):494–501

 

10.4088/JCP.09m05776blu

 

ABSTRACT

 

Objective: To examine the prevalence of antidepressant use in the absence of lifetime mental disorders and to examine sociodemographic correlates, indicators of need (hospitalization, suicidal behavior, perceived need, subthreshold disorders, disability, traumatic events), and antidepressant characteristics of such use.

 

Method: Data came from the Collaborative Psychiatric Epidemiologic Surveys (N = 20,013), a nationally representative cross-sectional sample of community-dwelling adults in the United States. Sociodemographic correlates and indicators of need were examined as predictors of past-year use of antidepressants in the absence of a lifetime DSM-IV diagnosis as assessed by the World Mental Health Composite Diagnostic Interview. The surveys were conducted between 2001 and 2003.

 

Results: Among individuals who took an antidepressant in the past year (n = 1,441), 396 (26.3%) did not meet criteria for any lifetime diagnosis assessed. Respondents taking antidepressants in the absence of a lifetime diagnosis tended to be older, white, and female. All indicators of need except past-year suicidal behavior were significant predictors (adjusted odds ratios ranging from 2.12 to 14.22, P < .001), with 89% of individuals taking antidepressants in the absence of a lifetime diagnosis endorsing at least 1 indicator of need. Individuals taking antidepressants in the absence of a DSM-IV disorder were more likely to have been prescribed these medications by family physicians or other doctors compared to psychiatrists.

 

Conclusions: These results suggest that antidepressant use among individuals without psychiatric diagnoses is common in the United States and is typically motivated by other indicators of need. These findings have important implications for the delivery of medical and psychiatric care and psychiatric nosology.

 

© Copyright 2011 Physicians Postgraduate Press, Inc.

 

(full text is available if needed here)

 

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Comment: Although published in April 2011, this is somewhat outdated (data from 2001-2003), it is possible that the percentage (of antidepressant users without any psychiatric diagnosis) increased in the meantime, since the antidepressant use increased dramatically. There are similar surveys for Europe and other countries, indicating that the majority of antidepressant users never fulfilled the criteria for prescription as given in common guidelines./-PhilRS.

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