Antidepressant medications have gained wider acceptance and popularity,
accompanied by declining use of psychotherapy, in the treatment of depression
in the United States from 1996 to 2005, a study published in the August
Archives of General Psychiatry demonstrates.
The authors, Mark Olfson, M.D., and Steven Marcus, Ph.D., compared the
rates of antidepressant use in 1996 and 2005 using data collected in the
Medical Expenditure Panel Survey (MEPS)—household component. The ongoing
survey was first conducted by the Agency for Healthcare Research and Quality
(AHRQ) in 1996.
In 2005 the annual rate of antidepressant use was estimated at 10.12
percent, nearly doubling from the 5.84 percent documented in 1996. Compared
with 1996, the rates of antidepressant use in 2005 increased with statistical
significance regardless of sex, age group, marital status, educational level,
family income, health insurance type, and employment status. The rate of
antidepressant use increased significantly among white and Hispanic, but not
Olfson is a professor of clinical psychiatry at Columbia University Medical
School and New York State Psychiatric Institute. Marcus is a research
associate professor at the University of Pennsylvania School of Social Policy
and Practice. The study was supported by grants from the AHRQ and the National
Alliance for Research on Schizophrenia and Depression.
During the year of MEPS, trained interviewers visited and interviewed a
large sample of households throughout the United States and asked respondents
to record their and their family members' health care visits, reasons for the
visits, and treatments including medications throughout the year. Their
diagnoses and health care visits were validated by respondents' medical
records. Olfson and Marcus limited their analyses to people 6 years and older
and included nearly 19,000 people from the 1996 survey and over 28,000 from
the 2005 survey.
Among people who were treated with antidepressants, 5.45 percent also
received antipsychotics in 1996, compared with 8.86 percent who also received
antipsychotics in 2005, while the percentage of patients who also received
psychotherapy declined significantly from 31.50 percent to 19.87 percent.
Meanwhile, the rate of inpatient mental health service decreased significantly
from 3.93 percent to 2.08 percent.
Fewer than 1 in 4 antidepressant users was being treated by a psychiatrist
in 2005. This information was not collected in the 1996 survey, thus making a
comparison impossible, Olfson told Psychiatric News. The rates of
treatment by psychologists and social workers were about 9 percent and 4
percent, respectively, in 2005.
The authors suggested a number of explanations for the increase in
antidepressant use, including more new drugs being approved, less stigma for
mental illness, growing acceptance of psychopharmacological treatment by the
public and general medical sectors, and a near fourfold increase in
direct-to-consumer advertising to promote antidepressant drugs. The
indications of antidepressants have expanded in the decade, which may also
explain the growth of their popularity. The percentage of all antidepressant
users who were being treated for depression barely changed from 1996 to
2005—from 26 percent to 27 percent. Other conditions for which they were
treated included back pain, anxiety, fatigue, and sleep disorder.
The study authors offered several possible explanations for the increased
antidepressant use. Two national surveys showed that the prevalence of major
depression in adults rose from 3.3 percent in 1991-1992 to 7.1 percent in
2001-2002. "It is difficult to know whether depression became more
common . . . or people just became more willing to disclose that they were
depressed. Whatever the reason, a larger percentage of the population endorsed
the symptoms of major depression in the later time period," said
"The overall increase in the use of antidepressants since the
mid-1990s is consistent with previous reports and with general clinical
experience," David Fassler, M.D., commented to Psychiatric
News. Fassler is a child psychiatrist and APA secretary-treasurer."
Physicians and the general public are more aware of the signs and
symptoms of depression, and treatment with medication is more widely
accepted." He found the decline in psychotherapy use unfortunate, as"
research clearly demonstrates that psychotherapy is a valuable and
important component of treatment for many people with depression."
Despite the increased rate of antidepressants, these data do not measure
the quality of diagnosis and treatment for patients with depression and other
mental illnesses, the authors acknowledged. They pointed out one disconcerting
dataset: 52 percent (1996) to 65 percent (2005) of MEPS respondents with
bipolar disorder were prescribed antidepressants. The effectiveness and risk
of antidepressants in bipolar treatment are still controversial.
"In the long run, the real issue isn't simply how many people are
taking antidepressants," said Fassler, but rather "whether or not
the right people are getting the most effective and appropriate intervention
Recent studies have suggested that the national trend of rising
antidepressant prescriptions since the 1990s may have flattened or reversed
since late 2004 when the Food and Drug Administration issued a series of
public warnings about increased risk of suicidality in young patients
associated with antidepressants (Psychiatric News, July 17). A boxed
warning was required for all antidepressant drug labels in February 2005. This
study, a cross-sectional comparison between 1996 and 2005, does not directly
address this more recent trend.
An abstract of "National Patterns in Antidepressant Medication
Treatment" is posted at<archpsyc.ama-assn.org/cgi/content/abstract/66/8/848>.▪