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antidepressants

A recent study published in The Journal of the American Medical Association (JAMA) found that the percentage of Americans taking antidepressants has nearly doubled since 1999.

Led by epidemiologist Elizabeth Kantor of Harvard University, researchers examined data from the National Health and Nutrition Examination Survey (NHANES) which includes results from 37,959 adults in the U.S. (“adults” here being defined as over the age of twenty.) The study does not, however, include people institutionalized.

Previous studies attempting to quantify our use of prescription drugs have relied mostly on secondary data sources, such as pharmacy or medical claims reports. What makes this study so important, and more reliable, is the fact that the data is derived directly from the population itself.

The study looked at Seven NHANES cycles taken from 1999-2000 to 2011-2012 with a sample size per cycle ranging from 4861 to 6212. Use of prescription drugs in the prior 30 days was assessed overall and by drug class for each cycle studied. Temporal trends across cycles were also evaluated.

What they found was that there was an overall increase of prescription drug use with 51% using one or more prescription drugs in 1999 and 59% doing so by 2002. Furthermore, the prevalence of polypharmacy (the use of ≥5 prescription drugs) increased from an estimated 8.2% in 1999-2000 to 15% in 2011-2012. From 1999 to 2012, the percentage of Americans on antidepressants specifically increased from 6.8% to 13%.

The rise in antidepressants was considered one of the most startling increases, with use steadily growing at every two-year measuring period. And these trends remained statistically significant when adjusted for age.

As the studies author discussed,

“The increase in use of antidepressant drugs may, in part, reflect shifting attitudes regarding depression.27 Use of SSRIs and SSNRIs markedly increased; notably, use of SSNRIs increased between 1999-2000 and 2005-2006, remaining stable thereafter. Even so, SSRIs remain much more commonly used than the other antidepressant drugs, and the continued popularity of the SSRIs may reflect the availability of several generic options with a wide range of indications and a favorable profile regarding adverse effects.”

Among the 18 drug classes examined over the study period, the rate of use increased in 11 of those drug classes, including: antihyperlipidemic agents, antidepressants, prescription proton-pump inhibitors, and muscle relaxants.

The problem with this significant increase in antidepressant prescriptions of course, is that there’s a lot of conflicting data on the actual effectiveness of antidepressants compared to placebo and psychotherapy, both in moderate and severe depression.

Another study published in JAMA back in October 2015 revealed that people diagnosed with severe depression show the same types of changes in brain scans when they respond to a placebo as they do when they take an actual antidepressant. A different study found that our previous understanding of response with antidepressants was vastly overestimated. Their reanalysis of data from the FDA archives for antidepressants approved between 1985 and 1997 found that the previously estimated 70% response with antidepressants was incorrect, and symptom reduction was actually at about 40% with antidepressants compared to about 30% with placebo.

Without statistically significant evidence that antidepressants are the correct or best solution for patients, perhaps we should reexamine the rate at which we are increasingly prescribing these medications.

Dr. Michael Reed is a Nashville based Psychiatrist. Please visit his main website for information about his career.