One in six American adults said they had taken a prescribed psychiatric drug, such as an antidepressant, a sedative or an antipsychotic, at least once during the previous year, according to a research letter published Monday in JAMA Internal Medicine.
Among whites, the percentage of adults who acknowledged taking such drugs was even higher: one in five. And more than 80 percent of the people who reported they had taken a psychiatric drug within the previous year said the prescription was for long-term use.
These findings, which are based on data from a 2013 national survey, are troubling, for they suggest that the use of psychiatric drugs in the United States is much more widespread than previously believed.
In an earlier study, which used data from a 2011 survey, slightly more than 1 in 10 American adults said they had taken prescription medication for “problems with emotions, nerves, or mental health.” But, as the authors of the current study point out, the 2011 survey did not provide information on the specific medications being prescribed or the length of time they were being used.
This new study set out to fill in that information gap.
For the study, Thomas Moore, a senior scientist at the Pennsylvania-based nonprofit Institute of Safe Medication Practices, and Dr. Donald Mattison, chief medical officer at the Ottawa-based Risk Sciences International, analyzed data collected from the 2013 Medical Expenditure Panel Survey, a government-run, nationally representative survey involving more than 37,000 adults.
They found that 16.7 percent of the adults surveyed said they had taken one or more prescription psychiatric drug(s) in 2013. The class of drugs most commonly reported was antidepressants (12 percent), followed by anxiolytics, sedatives and hypnotics (used to treat anxiety and insomnia) (8.3 percent), and antipsychotics (1.6 percent).
Large differences were found between whites and other racial and ethnic groups, with 20.8 percent of white adults reporting use of psychiatric drugs versus 9.7 of black adults, 8.7 of Hispanic adults and 4.8 percent of Asian-American adults (although the differences among those last three groups were not considered statistically significant).
The use of psychiatric drugs also increased with age, with 25 percent of adults aged 60 to 85 years using them compared with 9 percent of those aged 18 to 39 years and 18 percent of those 40 to 59. Women were almost twice as likely as men to have been recently prescribed a psychiatric drug.
Of the people who reported taking such drugs, 84 percent reported long-term use, which was defined in the study as having filled three or more prescriptions in 2013 or having started taking the drug during 2011 or earlier. Differences in long-term use among the three drug classes were small, the study also found.
Prescribing changes needed
The long-term use of the drugs was troubling, Moore and Mattison point out.
“In a previous study,” they explain, “we found most patients were long-term users of the hypnotic zopidem tartrate [Ambien] despite recommendations for short-term use, and many were combining it with other central nervous system depressants despite warnings.”
“Safe use of psychiatric drugs could be improved by increasing emphasis on prescribing these agents at the lowest effective dose and systematically reassessing the need for continued use,” they add.
‘No simple answers’
Glen Spielmans, a professor of psychology at Metropolitan State University who was not involved in the current study but has published frequently on the topic of the inappropriate marketing and prescribing of psychiatric drugs, said the new study’s findings are not that surprising.
“Research has consistently found that psychiatric drugs are widely used,” he wrote in an e-mail exchange with MinnPost.
Although Spielmans found the study interesting, he noted that it does not indicate the reasons the drugs were prescribed.
“Based on this study, it’s hard to know whether the prescriptions were appropriate,” he observed. “But other research has found that inappropriate prescribing of psychiatric drugs is common, so it’s quite likely that many of these prescriptions were unlikely to result in much benefit. Further, the study did not include stimulant use, which is increasing among adults.”
Spielmans also pointed out that the source of the problem with the inappropriate prescribing of psychiatric drugs often begins with the diagnosis.
“Drug companies market not just drugs, but also the conditions treated by drugs,” he explained. “Market the idea that [insert disorder here] is under-diagnosed and under-treated, leading to tragedies in terms of suffering and lost productivity. When these ‘disease awareness’ campaigns unfold, some previously undiagnosed people will be recognized as having a mental health problem and then benefit from treatment. On the flip side, many people who have normal life problems or other conditions (besides whichever one is currently ‘hot’) will be misdiagnosed and inappropriately receive medication. This has happened with ADHD, depression, bipolar disorder and other conditions — with binge eating disorder being the latest heavily marketed target for drug intervention.”
What does he think should be done?
“Good question,” he answered. “It would take a long time to cover all of the potential solutions. There are no simple answers and the current trend toward increased, often inappropriate, use of psychiatric medication seems likely to continue for the foreseeable future.”
FMI: You can read the study in full on the JAMA Internal Medicine website.