Psychiatric Drug Use Spreads
Pharmacy Data Show a Big Rise in Antipsychotic and Adult ADHD Treatments
By SHIRLEY S. WANG
The medicating of Americans for mental illnesses continued to grow over the past decade, with one in five adults now taking at least one psychiatric drug such as antidepressants, antipsychotics and anti-anxiety medications, according to an analysis of pharmacy-claims data.
Among the most striking findings was a big increase in the use of powerful antipsychotic drugs across all ages, as well as growth in adult use of drugs for attention-deficit hyperactivity disorder—a condition typically diagnosed in childhood. Use of ADHD drugs such as Concerta and Vyvanse tripled among those aged 20 to 44 between 2001 and 2010, and it doubled over that time among women in the 45-to-65 group, according to the report.
Overall use of psychiatric medications among adults grew 22% from 2001 to 2010. The new figures, released Wednesday, are based on prescription-drug pharmacy claims of two million U.S. insured adults and children reported by Medco Health Solutions Inc., a pharmacy-benefit manager.
„People from all walks of life are taking medications for mental-health conditions,“ said David Muzina, a psychiatrist and head of Medco’s Neuroscience Therapeutic Resource Center, whose team compiled the report.
While the use of most psychiatric drugs grew strongly, there were declines in antidepressant use in children and anti-anxiety drug use in the elderly, likely in part because of concern over potential side effects.
The patterns are consistent with, but more pronounced than, published findings from national government data, which tend to have a lag time. A recent Archives of General Psychiatry paper looking at data before 2005 found that about 10% of the population took an antidepressant. Wednesday’s data found that about 10% of adult men used antidepressants in 2010, but 21% in adult women did.
Psychiatric medications are among the most widely prescribed and biggest-selling class of drugs in the U.S. In 2010, Americans spent $16.1 billion on antipsychotics to treat depression, bipolar disorder and schizophrenia, $11.6 billion on antidepressants and $7.2 billion on treatment for ADHD, according to IMS Health, which tracks prescription-drug sales.
Whether psychiatric drugs are used appropriately or not has been a longstanding concern among medical professionals and policy makers in the U.S. Evidence continues to grow about possible serious side effects, particularly among children and the elderly. For instance, in 2004 the Food and Drug Administration required a „black box“ warning—its most serious—about the possible increase in suicidal thoughts in children and teens taking antidepressants, and in 2005 it warned about the increased risk of death with certain antipsychotics in elderly patients with dementia.
Wednesday’s report offered some evidence that such warnings have impact: Antidepressant use in children peaked in 2004 and dropped last year to 2001 levels, around 2.5% for girls and just over 2% for boys.
Still, there was a pronounced increase in medications to treat ADHD among young and middle-aged adults, particularly in women. Use in the over-65 population also increased about 30% for men and women between 2001 and 2010. An earlier study published in the New England Journal of Medicine found a similar trend in examining data between 2002 and 2005, and these latest figures suggest that the uptick isn’t slowing. Reasons for the rise could include people who were diagnosed and treated as children who continue to suffer from symptoms, adults who were never treated previously but suspect they have symptoms, and increased awareness from marketing pushes by companies approved to market these drugs to adults, Medco’s Dr. Muzina said.
Shire PLC, maker of Vyvanse and Adderall, pointed to an increased recognition of ADHD as a lifelong disorder as a main factor for growth in treatment in adults, as well as marketing and awareness campaigns have led to the awareness that this is a real entity, said Jeff Jonas, head of Shire research and development. Johnson & Johnson, maker of ADHD drug Concerta, declined to comment.
David Sallen was diagnosed in his mid-30s with attention deficit disorder, a variant of ADHD, after an extensive testing session at Massachusetts General Hospital in Boston. Though he had felt as a child that something was wrong with him, he never considered that he had ADD until one day in the late 1990s when he lost his train of thought when talking with a friend and jokingly said he thought he had ADD. The friend agreed, prompting Mr. Sallen to get tested. Mr. Sallen, of North Attleborough, Mass., started medication, eventually settling on the drug Adderall. On the medicine, he says he was able to fully shift his attention from one situation to the next rather than perseverate on a previous conversation, and could plan what he was going to do next rather than get distracted by a phone call and forget what he was doing. Mr. Sallen, who had been a college dropout, says he returned to get his degree and went to graduate school. „It was day and night,“ he said of his life before and after treatment.
Use of antipsychotics such as J&J’s Risperdal and Bristol-Myers Squibb Co.’s Abilify grew substantially in the past decade in both kids and adults. The rise, despite increased awareness about potential side effects like weight gain, high cholesterol and diabetes, is worrisome, according to Mark Olfson, a professor of clinical psychiatry at Columbia University who studies psychiatric drug utilization patterns but wasn’t involved in the current report.
Separate Medco data not included in the report find that only a minority of patients on these medicines is getting their blood sugar checked annually, according to Dr. Muzina. „When we see this trend of increasing use, it makes me wonder: Are patients appropriately followed with safety monitoring?“ he says.
In the elderly, the use of anti-anxiety drugs, particularly ones that stay in the body for a longer period of time like Valium, is a major worry, but there has been relatively little in the way of research on their use in this population, according to Dr. Olfson. These new data about the 44% decrease in use of these drugs in the elderly represent a major shift in usage patterns in the last decade and are an „encouraging development,“ he says.
The trend is likely in part related to the fact that these drugs aren’t covered by Medicare part D, which offers the drug coverage for seniors and came into effect in 2006, according to Dr. Muzina.