Psychotropic Medication Use in Canada

Article excerpt

Background: Psychotropic medication use can be employed as an indicator of appropriate treatment for mental disorders. The Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2) offers the first opportunity to characterize Canadian psychotropic medication use on a national level within diagnostic groups as assessed by a full version of the Composite International Diagnostic Interview (CIDI).

Method: We assessed the prevalence of antidepressant, sedative-hypnotic, mood stabilizer, psychostimulant, and antipsychotic use over 2 days overall and in subgroups defined by CIDI-diagnosed disorders and demographics. We employed sampling weights and bootstrap methods.

Results: Overall psychotropic drug utilization was 7.2%. Utilization was higher for women and with increasing age. With any lifetime CIDI-diagnosed disorder assessed in the CCHS 1.2, utilization was 19.3%, whereas without such disorders, it was 4.1%. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly used antidepressants for those with a past-year major depressive episode (17.8%), followed by venlafaxine (7.4%). Among people aged 15 to 19 years, antidepressant use was 1.8% overall and 11.7% among those with past-year depression; SSRIs made up the majority of use. Sedative-hypnotics were used by 3.1% overall, increasing with age to 11.1% over 75 years.

Conclusions: International comparison is difficult because of different evaluation methods, but antidepressant use may be higher and antipsychotic use lower in Canada than in recent European and American reports. In light of the relative lack of contemporary evidence for antidepressant efficacy in adolescents, it is likely that antidepressant use among those aged 15 to 19 years will continue to decline. The increased use of sedative-hypnotics with age is of concern, given the associated risk of adverse effects among seniors.

(Can J Psychiatry 2005;50:605-613)

Information on funding and support and author affililations appears at the end of the article.

Clinical Implications

* Psychotropic medication use is common, with 7.2% of the general population taking at least one such medication.

* Only a minority (approximately 19%) of those with a lifetime history of a mental disorder are using a psychotropic medication.

* Canadians over age 75 years are the highest users of sedative-hypnotic drugs, in spite of significant risks of adverse effects in the elderly.

Limitations

* Comparison with other surveys is complicated by different evaluation time frames and different methods of assessment of medication use.

* A detailed assessment of treatment quality was not possible, since information on daily dosage and treatment duration was not collected and the indication for which each medication was used was not recorded.

* The CCHS 1.2 assessed a limited number of mental disorders. Thus the prevalence of "any" lifetime mental disorder may be underestimated, while that of "no" lifetime disorder may be overestimated; drug utilization estimates in these groups may also be affected.

Key Words: cross-sectional studies, drug utilization, psychotropic drugs, antidepressive agents, hypnotics and sedatives, antianxiety agents, antimanic agents, antipsychotic agents, mental disorders, Canada

Psychotropic drug utilization rates can be useful in monitoring treatment for mental disorders on a population basis. Moreover, they provide information regarding rational drug use, given current knowledge regarding the risks and benefits of a given medication.

Although data from administrative sources such as physician billings and prescription drug plans are often used in drug utilization studies, these data can be inaccurate and generally do not cover the entire population. Moreover, they cannot provide information on whether medications are actually taken. Population-based surveys that include detailed questions on medication use provide an opportunity to circumvent these problems. …