The number of Americans treated with antidepressants doubled in less than a decade, from about 13 million in 1996 to 27 million in 2005, according to a report in the August issue of the Archives of General Psychiatry.
National surveys show that the number of antidepressant prescriptions per user also increased, as did the number of people who received antipsychotic medications or mood stabilizers in addition to antidepressants. Meanwhile, the number of people who underwent psychotherapy declined.
These broad 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," said Dr. Mark Olfson of Columbia University and the New York State Psychiatric Institute, New York, and Steven C. Marcus, Ph.D., of the University of Pennsylvania, Philadelphia.
However, in the wake of the Food and Drug Administration's black box requirement for selective serotonin reuptake inhibitors, more recent data indicate that psychiatrists and general physicians are prescribing fewer antidepressants than they were before the warnings ("Are Warnings on Antidepressants Backfiring?" CLINICAL PSYCHIATRY NEWS, JULY 2007, p. 8.)
The study of older trends by Dr. Olfson and Dr. Marcus is the first to document trends in antidepressant use by using surveys of nationally representative samples--the Medical Expenditure Panel Surveys (MEPS) for 1996 (18,993 subjects) and 2005 (28,445 subjects).
The MEPS tracks the use of all health care services for 1 year among all members of participating households who are aged 6 years and older. The data are verified through contact with all hospitals, medical care providers, home health agencies, and pharmacies used by the survey respondents.
Between 1996 and 2005, the annual rate of antidepressant use increased from 5.8% to 10.1% of the population, which corresponds to a national increase from 13.3 million to 27 million people (Arch. Gen. Psychiatry 2009;66:848-56). This rise was seen in both males and females, across all age groups, and regardless of the subjects' marital status, education level, type of health insurance, and employment status. However, the rates of antidepressant use remain low among African Americans and Hispanics, compared with whites.
"Much remains to be learned about the roles of culturally mediated beliefs, attitudes, and social norms and physician factors in shaping racial/ethnic trends in antidepressant use," Dr. Olfson and Dr. Marcus wrote. The mean number of antidepressant prescriptions per person also increased, from 5.6 in 1996 to 6.9 in 2005.
Dr. David Fassler, who was not involved with the study, said in an interview that the overall increase in the use of antidepressants during that period makes sense, because physicians and the general public are more aware of the signs and symptoms of depression, and treatment with medication is more widely accepted. …