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Antidepressant Use in U.S. Has Almost Doubled

Study also finds increases in use of other psychotropic medications

MONDAY, Aug. 3 (HealthDay News) -- Antidepressant use among U.S. residents almost doubled between 1996 and 2005, along with a concurrent rise in the use of other psychotropic medications, a new report shows.

The increase seemed to span virtually all demographic groups.

"Over 10 percent of people over the age of 6 were receiving anti-depression medication. That strikes me as significant," said study author Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University/New York State Psychiatric Institute in New York City.

According to background information in the study, antidepressants are now the most widely prescribed class of drugs in the United States. The expansion in use dates back to the 1980s, with the introduction of the antidepressant Prozac (fluoxetine).

The study found that 5.84 percent of U.S. residents aged 6 and over were using antidepressants in 1996, compared with 10.12 percent in 2005. That's 13.3 million people, up to 27 million people.

"This is a 20-year trend and it's very powerful," remarked Dr. Eric Caine, chair of the department of psychiatry and co-director of the Center for the Study of Prevention of Suicide at the University of Rochester Medical Center.

This happened despite a "black box" warning mandated for many antidepressant medications by the U.S. Food and Drug Administration in 2004, the study authors noted.

Lower rates of increases in antidepressant use were seen in blacks (3.61 percent in 1996 versus 4.51 percent in 2005) and in Hispanics (3.72 percent versus 5.21 percent in 2005), the researchers found.

Still, about the same number of people were being treated for depression (26.25 percent in 1996 versus 26.85 percent in 2005), indicating that the drugs were being used to treat other diagnoses, such as anxiety and other mood disorders.

At the same time, those receiving antipsychotic medications increased from 5.46 percent to 8.86 percent, and the proportion of people using psychotherapy dropped from 31.5 percent to 19.87 percent.

"The reasons [for the growth] are unclear but they may include the introduction of new antidepressants over the last 10 to 12 years or so and a broadening in the clinical indications of antidepressant treatment. Years ago, these drugs were largely focused on depression. Today, more different conditions are treated with antidepressants," Olfson said. "There's also been an increase in direct-to-consumer advertising and a lessening of the stigma associated with seeking mental health care."

Indeed, a study released last week found that roughly five of six Americans now have a positive opinion on psychiatric medications, a marked increase from about a decade ago.

Depression may also be more common in the population, or at least more people may be acknowledging it and seeking help, the authors suggested.

"It is encouraging that there is apparently an increased awareness and increased willingness to seek assistance for emotional distress . . . and that is a big step forward," said Dr. Kathryn J. Kotrla, chairwoman and associate professor of psychiatry and behavioral science at Texas A&M Health Science Center College of Medicine.

"I think part of the increased rate is increased awareness, as well as national depression screening all over the country," added Dr. M. Beatriz Currier, an associate professor of clinical psychiatry at the University of Miami Miller School of Medicine. "Education and screening decrease stigma."

Of concern, however, was the finding that the majority of Americans taking antidepressants were not receiving care from a psychiatrist.

Also troubling was not knowing what the prescriptions were being written for exactly.

"One wonders if the medication is being used as a possible panacea for a number of psychosocial issues which might be better served by counseling," Kotrla said.

"Who's really taking these medications?" Caine said. "It's not clear that it makes anyone healthier. That's a fundamental issue that we don't know. We don't have any way of telling if this made people's lives better."

A second study in the same issue of the journal followed 306 preschoolers aged 3 to 6 years for 24 months and found that depression in this group tends not to just go away as the child gets older, but can linger as a chronic condition.

"This is exciting because it gives us an opportunity for early intervention," Kotrla said.

More information

The U.S. National Institute of Mental Health has more on depression.

SOURCES: Mark Olfson, M.D., professor, clinical psychiatry, Columbia University/New York State Psychiatric Institute, New York City; Eric Caine, M.D., chair, department of psychiatry, and co-director, Center for the Study of Prevention of Suicide, University of Rochester Medical Center, N.Y.; Kathryn J. Kotrla, M.D., chairwoman and associate professor, psychiatry and behavioral science, Texas A&M Health Science Center College of Medicine, and associate dean, Texas A&M Health Science Center College of Medicine Round Rock campus; M. Beatriz Currier, M.D., associate professor, clinical psychiatry, University of Miami Miller School of Medicine; August 2009 Archives of General Psychiatry

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