National prevalence of receipt of antidepressant prescriptions by persons without a psychiatric diagnosis.
OBJECTIVE
The study addressed recent concerns regarding increasing prescription of antidepressant drugs to patients with no recorded psychiatric diagnosis.


METHODS
Records from ten large integrated health systems in the Mental Health Research Network were used to examine diagnoses received by 1,011,946 health plan members who filled at least one antidepressant prescription in 2010.


RESULTS
Among individuals filling antidepressant prescriptions, psychiatric diagnoses recorded during the year were depressive disorders (48%), anxiety disorders (27%), bipolar disorders (3%), and attention deficit disorders (3%). The proportion of those filling prescriptions who had no psychiatric diagnosis was 39%, which fell to 27% after the analysis excluded prescriptions for antidepressants often prescribed for nonpsychiatric indications (tricyclic antidepressants, trazodone, and bupropion).


CONCLUSIONS
Prescription of antidepressants to patients without an appropriate diagnosis appears to be less common than previously reported.
Dr. Simon and Dr. Stewart are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: simon.g@ghc.org). Dr. Beck is with the Institute for Health Research, Kaiser Permanente of Colorado, Denver. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena. Dr. Whitebird is with HealthPartners Institute for Education and Research, Minneapolis, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Owen-Smith is with the Center for Health Research, Kaiser Permanente Georgia, Atlanta. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Soumerai is with the Department of Population Medicine, Harvard Medical School, Boston. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland.
Gregory E
GE
Simon
Dr. Simon and Dr. Stewart are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: simon.g@ghc.org). Dr. Beck is with the Institute for Health Research, Kaiser Permanente of Colorado, Denver. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena. Dr. Whitebird is with HealthPartners Institute for Education and Research, Minneapolis, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Owen-Smith is with the Center for Health Research, Kaiser Permanente Georgia, Atlanta. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Soumerai is with the Department of Population Medicine, Harvard Medical School, Boston. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland.
Christine
C
Stewart
Dr. Simon and Dr. Stewart are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: simon.g@ghc.org). Dr. Beck is with the Institute for Health Research, Kaiser Permanente of Colorado, Denver. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena. Dr. Whitebird is with HealthPartners Institute for Education and Research, Minneapolis, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Owen-Smith is with the Center for Health Research, Kaiser Permanente Georgia, Atlanta. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Soumerai is with the Department of Population Medicine, Harvard Medical School, Boston. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland.
Arne
A
Beck
Dr. Simon and Dr. Stewart are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: simon.g@ghc.org). Dr. Beck is with the Institute for Health Research, Kaiser Permanente of Colorado, Denver. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena. Dr. Whitebird is with HealthPartners Institute for Education and Research, Minneapolis, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Owen-Smith is with the Center for Health Research, Kaiser Permanente Georgia, Atlanta. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Soumerai is with the Department of Population Medicine, Harvard Medical School, Boston. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland.
Brian K
BK
Ahmedani
Dr. Simon and Dr. Stewart are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: simon.g@ghc.org). Dr. Beck is with the Institute for Health Research, Kaiser Permanente of Colorado, Denver. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena. Dr. Whitebird is with HealthPartners Institute for Education and Research, Minneapolis, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Owen-Smith is with the Center for Health Research, Kaiser Permanente Georgia, Atlanta. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Soumerai is with the Department of Population Medicine, Harvard Medical School, Boston. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland.
Karen J
KJ
Coleman
Dr. Simon and Dr. Stewart are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: simon.g@ghc.org). Dr. Beck is with the Institute for Health Research, Kaiser Permanente of Colorado, Denver. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena. Dr. Whitebird is with HealthPartners Institute for Education and Research, Minneapolis, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Owen-Smith is with the Center for Health Research, Kaiser Permanente Georgia, Atlanta. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Soumerai is with the Department of Population Medicine, Harvard Medical School, Boston. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland.
Robin R
RR
Whitebird
Dr. Simon and Dr. Stewart are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: simon.g@ghc.org). Dr. Beck is with the Institute for Health Research, Kaiser Permanente of Colorado, Denver. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena. Dr. Whitebird is with HealthPartners Institute for Education and Research, Minneapolis, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Owen-Smith is with the Center for Health Research, Kaiser Permanente Georgia, Atlanta. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Soumerai is with the Department of Population Medicine, Harvard Medical School, Boston. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland.
Frances
F
Lynch
Dr. Simon and Dr. Stewart are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: simon.g@ghc.org). Dr. Beck is with the Institute for Health Research, Kaiser Permanente of Colorado, Denver. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena. Dr. Whitebird is with HealthPartners Institute for Education and Research, Minneapolis, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Owen-Smith is with the Center for Health Research, Kaiser Permanente Georgia, Atlanta. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Soumerai is with the Department of Population Medicine, Harvard Medical School, Boston. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland.
Ashli A
AA
Owen-Smith
Dr. Simon and Dr. Stewart are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: simon.g@ghc.org). Dr. Beck is with the Institute for Health Research, Kaiser Permanente of Colorado, Denver. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena. Dr. Whitebird is with HealthPartners Institute for Education and Research, Minneapolis, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Owen-Smith is with the Center for Health Research, Kaiser Permanente Georgia, Atlanta. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Soumerai is with the Department of Population Medicine, Harvard Medical School, Boston. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland.
Beth E
BE
Waitzfelder
Dr. Simon and Dr. Stewart are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: simon.g@ghc.org). Dr. Beck is with the Institute for Health Research, Kaiser Permanente of Colorado, Denver. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena. Dr. Whitebird is with HealthPartners Institute for Education and Research, Minneapolis, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Owen-Smith is with the Center for Health Research, Kaiser Permanente Georgia, Atlanta. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Soumerai is with the Department of Population Medicine, Harvard Medical School, Boston. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland.
Stephen B
SB
Soumerai
Dr. Simon and Dr. Stewart are with the Group Health Research Institute, Group Health Cooperative, Seattle, Washington (e-mail: simon.g@ghc.org). Dr. Beck is with the Institute for Health Research, Kaiser Permanente of Colorado, Denver. Dr. Ahmedani is with the Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. Dr. Coleman is with the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena. Dr. Whitebird is with HealthPartners Institute for Education and Research, Minneapolis, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Owen-Smith is with the Center for Health Research, Kaiser Permanente Georgia, Atlanta. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Soumerai is with the Department of Population Medicine, Harvard Medical School, Boston. Ms. Hunkeler is with the Division of Research, Kaiser Permanente Northern California, Oakland.
Enid M
EM
Hunkeler
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D015995:Prevalence; D014481:United States
D000928:Antidepressive Agents