National patterns in antidepressant medication treatment

Arch Gen Psychiatry. 2009 Aug;66(8):848-56. doi: 10.1001/archgenpsychiatry.2009.81.

Abstract

Context: Antidepressants have recently become the most commonly prescribed class of medications in the United States.

Objective: To compare sociodemographic and clinical patterns of antidepressant medication treatment in the United States between 1996 and 2005.

Design: Analysis of antidepressant use data from the 1996 (n = 18 993) and 2005 (n = 28 445) Medical Expenditure Panel Surveys.

Setting: Households in the United States.

Participants: Respondents aged 6 years or older who reported receiving at least 1 antidepressant prescription during that calendar year.

Main outcome measures: Rate of antidepressant use and adjusted rate ratios (ARRs) of year effect on rate of antidepressant use adjusted for age, sex, race/ethnicity, annual family income, self-perceived mental health, and insurance status.

Results: The rate of antidepressant treatment increased from 5.84% (95% confidence interval [CI], 5.47-6.23) in 1996 to 10.12% (9.58-10.69) in 2005 (ARR, 1.68; 95% CI, 1.55-1.81), or from 13.3 to 27.0 million persons. Significant increases in antidepressant use were evident across all sociodemographic groups examined, except African Americans (ARR, 1.13; 95% CI, 0.89-1.44), who had comparatively low rates of use in both years (1996, 3.61%; 2005, 4.51%). Although antidepressant treatment increased for Hispanics (ARR, 1.75; 95% CI, 1.60-1.90), it remained comparatively low (1996, 3.72%; 2005, 5.21%). Among antidepressant users, the percentage of patients treated for depression did not significantly change (1996, 26.25% vs 2005, 26.85%; ARR, 0.95; 95% CI, 0.83-1.07), although the percentage of patients receiving antipsychotic medications (5.46% vs 8.86%; ARR, 1.77; 95% CI, 1.31-2.38) increased and those undergoing psychotherapy declined (31.50% vs 19.87%; ARR, 0.65; 95% CI, 0.56-0.72).

Conclusions: From 1996 to 2005, there was a marked and broad expansion in antidepressant treatment in the United States, with persisting low rates of treatment among racial/ethnic minorities. During this period, individuals treated with antidepressants became more likely to also receive treatment with antipsychotic medications and less likely to undergo psychotherapy.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adjustment Disorders / drug therapy*
  • Adjustment Disorders / economics
  • Adolescent
  • Adult
  • African Americans / statistics & numerical data
  • Aged
  • Antidepressive Agents / economics
  • Antidepressive Agents / therapeutic use*
  • Antipsychotic Agents / therapeutic use
  • Child
  • Depressive Disorder / drug therapy
  • Depressive Disorder / economics
  • Drug Costs / statistics & numerical data
  • Drug Costs / trends
  • Drug Prescriptions / economics
  • Drug Prescriptions / statistics & numerical data*
  • Drug Utilization / economics
  • Drug Utilization / statistics & numerical data
  • Drug Utilization / trends
  • Female
  • Health Care Surveys / statistics & numerical data
  • Health Expenditures / statistics & numerical data
  • Health Expenditures / trends
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Psychotherapy / trends
  • United States

Substances

  • Antidepressive Agents
  • Antipsychotic Agents