National patterns in antidepressant medication treatment.
BACKGROUND
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.


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


METHODS
Households in the United States.


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


METHODS
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.
Olfson
Mark
M
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. mo49@columbia.edu
Marcus
Steven C
SC
D000275:Adjustment Disorders / Q000188:drug therapy* / Q000191:economics; D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002648:Child; D003866:Depressive Disorder / Q000188:drug therapy / Q000191:economics; D016527:Drug Costs / Q000706:statistics & numerical data / Q000639:trends; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data / Q000639:trends; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011613:Psychotherapy / Q000639:trends; D014481:United States
D000928:Antidepressive Agents; D014150:Antipsychotic Agents