A new analysis published on Monday in JAMA Internal Medicine reveals that approximately one in six adults in the United States is taking at least one psychiatric drug, most commonly an antidepressant or antianxiety drug. The findings underscore the legal drug epidemic plaguing this country as Americans have become increasingly dependent on pharmaceuticals.
The study — co-authored by Thomas J. Moore, a researcher at the Institute for Safe Medication Practices, and Donald Mattison of Risk Sciences International — is based on 2013 surveys and insurance data compiled by the Agency for Healthcare Research and Quality. In particular, the analysis examined three classes of psychiatric drugs: antidepressants; antianxiety medications, including sedatives and hypnotics primarily used to treat anxiety and insomnia; and antipsychotics, for patients suffering from conditions such as bipolar disorder and schizophrenia.
Specifically, the top 10 psychiatric drugs reported in the new study were sertraline hydrochloride (Zoloft, an antidepressant); citalopram hydrobromide (Celexa, an antidepressant); alprazolam (Xanax, an anti-anxiety drug); zolpidem tartrate (Ambien, a hypnotic); fluoxetine hydrochloride (Prozac, an antidepressant); trazodone hydrochloride (Desyrel, an antidepressant); clonazepam (Klonopin, an anti-anxiety drug); lorazepam (Ativan, an anti-anxiety drug); escitalopram oxalate (Lexapro, an antidepressant); and duloxetine hydrochloride (Cymbalta, an antidepressant).
The study produced a number of startling findings, including that prescription drug use is unevenly distributed across the population, depending on a number of demographics, and in most cases is long-term.
The researchers found that 16.7 percent of adults reported filling one or more prescriptions for psychiatric drugs in 2013, of which 12 percent of adults reported antidepressant use; 8.3 percent reported taking anti-anxiety meds, sedatives and hypnotics; and 1.6 percent used antipsychotics.
The authors found that women were more likely to report taking a psychiatric drug than men. In 2013, one in five women had filled at least one psychiatric drug prescription that year.
According to the study, the numbers vary dramatically depending on race: 20.8 percent of white adults reported use of psychiatric drugs, compared with 8.7 percent of Hispanic adults, 9.7 percent of black adults and 4.8 percent of Asian adults.
Dr. Krakower believes part of the reason for this discrepancy is that psychiatry is an underrepresented speciality in certain areas of the country.
The study also found that age plays a role, as adults between the ages of 60 and 85 are now the highest users of psychiatric medicines, with over a quarter of that population reporting use, as compared to 9 percent amongst those between the ages of 18 and 39 and 18 percent amongst those between the ages of 40 and 59.
For some in the science community, it is particularly surprising and disconcerting that so many elderly people are taking these types of medications because of the side effects these drugs can cause, including falls and cognitive impairment. "It used to be middle-aged adults were the highest users of these drugs; now it's older adults," said Dr. Eric Lenze, a professor of psychiatry at the Washington University School of Medicine, not affiliated with the study. He said this finding is "new and fairly eye-opening.”
Additionally, Moore and Mattison say the majority of adults in the survey who reported taking psychiatric medications have been using them a long time.
Eighty-four percent of those who reported psychiatric drug use had filled three or more prescriptions in 2013, which the authors considered long-term use. The most commonly used type of drug was an antidepressant, followed by an antianxiety drug or sleeping pill.
"My concern about the extensive long-term use is that eight of the 10 most widely used drugs either have warnings about withdrawal symptoms, are DEA Schedule IV or both," Moore said. "Both patients and physicians need to periodically re-evaluate the continued need for psychiatric drugs."
The co-authors were surprised by what they learned in the study. “I follow this area, so I knew the numbers would be high,” said Moore. “But in some populations, the rates are extraordinary.”
What’s more, as the numbers are based on self-reported data, they could actually be higher, says Moore.
While the authors did not advance theories for the significant prevalence of prescription drug use in the country, it may in fact be the result of expanded medical terms and definitions.
Slate.com predicted this would happen in 2013:
Beware the DSM-5, the soon-to-be-released fifth edition of the "psychiatric bible," the Diagnostic and Statistical Manual. The odds will probably be greater than 50 percent, according to the new manual, that you’ll have a mental disorder in your lifetime.
Although fewer than 6 percent of American adults will have a severe mental illness in a given year, according to a 2005 study, many more — more than a quarter each year — will have some diagnosable mental disorder. That’s a lot of people. Almost 50 percent of Americans (46.4 percent to be exact) will have a diagnosable mental illness in their lifetimes, based on the previous edition, the DSM-IV. And the new manual will likely make it even "easier" to get a diagnosis.
The expanded definitions have resulted in significant increases in diagnoses of mental disorders.
Additionally, Consumer Reports contends that an increase in prescription drug use can be attributed to aggressive drug marketing that overhypes the benefits of the pharmaceuticals and downplays their risks. "Antipsychotics have become huge moneymakers for the drug industry. In 2003, annual U.S. sales of the drugs were estimated at $2.8 billion; by 2011, that number had risen to $18.2 billion," it wrote.
Meanwhile, with patients and doctors seeking immediate relief for certain symptoms, too many Americans are opting for prescription medications when they may indeed not always be necessary.
Dr. Mark Olfson, a professor of psychiatry at Columbia University, makes a similar observation: “It reflects a growing acceptance of and reliance on prescription medications” to manage common emotional problems, he said.
And while the JAMA study focuses only on adults, America’s youth has not been unaffected by the prescription drug epidemic.
Data from the Centers for Disease Control revealed last year that there continues to be a significant increase in the number of school-age children on psychiatric medications to treat emotional or behavioral problems. One health study shows that 7.5 percent of children between the ages of six and 17 are on psych meds, based on data collected from interviews between 2011 and 2012 with parents of over 17,000 children.
“Over the past two decades, the use of medication to treat mental health problems has increased substantially among all school-aged children and in most subgroups of children,” that report’s authors explained.
The survey did not identify which diagnoses were being treated by the medications, but estimates indicate that a majority of the drugs are to treat ADHD symptoms. However, according to the American Psychiatric Association, five percent of American children have ADHD, but studies reveal more than 11 percent of American children are diagnosed with the condition.
The JAMA study report is just the latest to underscore once more that there is a definite overmedication problem in the United States.