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Use Of Antidepressants And Stimulants Increasing CHICAGO, IL -- February 17, 1998 -- Prescriptions for antidepressants and stimulants by office-based physicians increased dramatically from 1985 to 1994, according to an article in tomorrow’s issue of The Journal of the American Medical Association. Harold Alan Pincus, M.D., of the American Psychiatric Association in Washington, MD., and colleagues examined the prescribing patterns of primary care physicians, psychiatrists and other medical specialists. They used data from the National Ambulatory Medical Care Survey which samples a representative group of visits to office-based physicians. It does not include hospital settings, federal facilities, emergency departments, or outpatient hospital-based clinics. The researchers found that use of psychotropic medications changed dramatically over the 10-year period. "The number of visits during which a psychotropic medication was prescribed increased from 32.73 million to 45.64 million," they write. “The proportion of such visits, as a proportion of all visits, increased from 5.1 percent to 6.5 percent. "Anti-anxiety or hypnotic drug visits, previously the largest category are now surpassed by antidepressant visits." The researchers noted a five-fold increase in stimulant drug visits during the period, from 1.5 percent to 5.1 percent of all psychotropic drug visits. "This increase is the result of the significant rise in the number and proportion of stimulant visits by children and adolescents [from 0.31 million to 2.41 million visits]." These visits are associated with the diagnosis of attention deficit hyperactivity disorder (ADHD). Visits by children and adolescents for all types of psychotropic medications increased significantly, from 1.10 million in 1985 to 3.73 million visits in 1993 and 1994. Among other findings of the survey: -- Visits for anti-anxiety and hypnotic drugs decreased from 1985 to 1994 -- There was no significant rise in the number of visits for anti-psychotic drugs or lithium -- No significant differences over time were associated with the sex of the patient Psychotropic medications, medications that have an effect on the mind, are among the most widely-prescribed medications in the United States. As a class, they represented 8.8 percent of the prescription drug market in 1994, and their use has been increasing in recent years, according to information cited in the study. The researchers report the growth in antidepressant visits is a result of the use of a new class of drugs known as selective serotonin reuptake inhibitors (SSRIs). The first SSRI, fluoxetine hydrochloride, was introduced in 1988. Since then, three more SSRIs have been brought to the market. The surveys showed a greatly expanded use of SSRIs by psychiatrists, as compared with primary care and other physicians. The researchers suggest this may be because psychiatrists are closer to the initial research literature on these newer drugs. "Psychiatrists, therefore, may be more on the cutting edge of new technological developments in depression treatment," the researchers write. The researchers suggest that the structure of health care delivery and health care reimbursement may be affecting the use of psychotropic drugs. "In many managed care organisations, the incentives of a capitated system would encourage primary care physicians to maintain responsibility for their patients with mental disorders, treat them efficiently with medications and not refer them for specialty care," they write. The authors said much more information is needed, especially on the clinical reasoning behind the selection of these medications. E-mail this page to a friend or colleague! To print, use this version