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A new study in the February 18 Journal of the American Medical Association shows a dramatic increase in the number of antidepressant and stimulant drug prescriptions by office-based physicians over a 10-year period.
Researchers led by Harold Pincus, M.D., an APA deputy medical director and head of the Office of Research, found that antidepressant drugs replaced antianxiety or hypnotic drugs as the largest category of psychotropic drug prescriptions in 1994.
"What we are seeing is a real change in the treatment of mental disorders, which reflects a growth in psychiatric research, the availability of newer types of medications with lower side effects especially the SSRI's, and less stigma associated with mental illness by society as a whole," Pincus told Psychiatric News.
The number of antidepressant drug prescriptions rose from 12 million in 1985 to 25 million in 1994, whereas the number of antianxiety/hypnotic drug prescriptions declined from 20 million to 18 million in that same period.
Psychiatrists were responsible for the largest increase of antidepressant drug prescriptions of any specialty. The number of prescriptions in this category rose from 4 million to 11 million between 1985 and 1994.
The report was cowritten by several researchers, including Deborah Zarin, M.D., an APA deputy medical director and co-director of the Office of Research; Terri Tanelian, research manager of APA's Office of Research; and James Thompson, M.D., M.P.H., an APA deputy medical director and head of the Office of Education.
The researchers examined the prescribing patterns of primary care physicians, general and child psychiatrists, psychoanalysts, and other physicians using 1985 and 1993 and 1994 data from the National Ambulatory Medical Care Survey. Potential limitations of the data included examining solely office-based visits, relying solely on physician reports, and possibly oversampling frequent users of care, according to the authors.
The researchers attributed the dramatic increase in antidepressant prescriptions to the introduction of SSRI's in 1988.
More psychiatrists prescribed SSRI's in 1994 than primary care physicians, which suggests that psychiatrists are closer to the initial research literature on newer drugs.
"Psychiatrists, therefore, may be more on the cutting edge of new technological developments in depression treatment," the authors stated.
Psychiatrists also experienced the greatest rate of increase in psychotropic drug prescriptions between 1985 and 1994, from 7.7 million to 15 million. However, primary care physicians continued to have the greatest number of psychotropic drug prescriptions (22 million).
Psychotropic drugs included antianxiety agents, antidepressants, antipsychotics, and stimulants.
Researchers also found a dramatic increase in the number of prescriptions for stimulant drugs, which rose fivefold between 1985 and 1994 (from 600,000 to 2.9 million).
"The large increase reflects a dramatic rise in visits by children and adolescents associated with ADHD," stated the authors.
Primary care physicians experienced a significant increase in stimulant drug prescriptions, from 300,000 in 1985 to 1.54 million in 1994, whereas psychiatrists did not. Primary care physicians also had three times the number of stimulant drug prescriptions by psychiatrists in 1994.
"Overall, there was a tenfold increase in psychotropic drug prescriptions by children to primary care physicians," the authors stated.
In contrast, the number of antipsychotic drug prescriptions did not rise significantly; however, an increased proportion of these prescriptions were by psychiatrists.
"Looking across the psychotropic drug categories, it is apparent that a dramatic change has occurred in the nature of the practice of psychiatry," said the authors.
For example, there has been a rising trend in the proportion of antianxiety drug prescriptions by psychiatrists, which may be linked to psychopharmacological research supporting expanded indications for benzodiazepines and alprazolam for the conditions most likely to be treated by psychiatrists.
Moreover, the development of practice guidelines in the past decade for treating a range of mental disorders may also have had an impact. Practice guidelines include "systematically gathered and assessed relevant data, which are integrated into treatment recommendations," the authors stated.