Researchers Analyze Prescription Rates for Psychiatric Medications

Tami K. Mark, PhD, and colleagues analyzed data from the 2005 National Disease and Therapeutic Index (NDTI) in order to examine which disease states psychiatric medications were being prescribed for. The NDTI is a continuing survey of over 4,000 office-based United States-based physicians. These physicians provide quarterly reports detailing their contact with patients and recording patient demographics, diagnosis, and therapies.

Via an e-mail interview, Dr. Mark stated their reasoning for conducting this research: “As part of an ongoing SAMHSA study to document how much is spent on mental health care in the US, we regularly conduct focused studies to better understand how specific types of mental health services are provided. In the area of psychotopic medications, we were frequently being asked whether most spending was for psychiatric illnesses, or whether it was often for medical illnesses, some of which may be off-label. We thus set out to better document the reasons why physicians were prescribing psychiatric medications.”

Mark and colleagues found that ~93% of antidepressants were prescribed for psychiatric conditions. Mood disorders accounted for 65.3% of mentions and anxiety disorders accounted for 16.4%. They also found that ~67% of anti-anxiety medications were prescribed for psychiatric conditions, with anxiety disorders accounted for ~40% of mentions and mood disorders accounted for ~19%.

They also found that ~99% of antipsychotics were prescribed for psychiatric conditions. Mood disorders, such as depression and bipolar disorder, accounted for 39% of mentions and schizophrenia or other psychiatric disorders accounted for 34.5% of mentions. Delirium, dementia, amnestic or other cognitive disorders accounted for 7.4% of drug mentions. Attention-deficit/hyperactivity disorder (ADHD) accounted for 5.7% of mentions and anxiety disorders accounted for 5.5%. Disorders diagnosed in infancy/childhood/adolescence, such as autism, accounted for 2.3% of mentions. Whether or not the prescription was on- or off-label was not part of the analysis.

“We were somewhat surprised at the small amount of non-psychiatric use of antidepressants (only ~7%) because some prior smaller studies found higher uses for medical purposes such as headache and chronic pain. The fact that ~33% of anti-anxiety medications were not prescribed for psychiatric diagnoses was also interesting. Approximately 6% of prescriptions were indicated as prescribed for a ‘medication examination/evaluation,’ thus presumably to relieve anxiety associated with the interventions.

“There has been considerable discussion in the scientific literature about the widening use of antipsychotics for a variety of psychiatric conditions and this study systematically documents this phenomenon. We found that the most common use for antipsychotics was not schizophrenia, but mood disorders, and that use for ADHD and dementia were common, despite being off-label,” Dr. Mark wrote.

The researchers hope that this analysis will be able to serve as a guide for future research, policy, and education about psychiatric medications, as well as their benefits, risks, and uses.

Funding for this research was provided by the Substance Abuse and Mental Health Services Administration to Thomson Reuters. (CNS Drugs. 2010;24(4):319-326). –CN

Rapid Cycling More Likely in Patients With Bipolar Disorder and Comorbid Substance Abuse

A recent study provided new evidence regarding specific characteristics that differentiate patients with bipolar disorder and comorbid substance use disorders (SUDs) from those who do not have comorbid SUDs.

Data were derived from the largest study on the treatment of bipolar disorder, the Systemic Treatment Enhancement Program, in which 2,154 patients with a diagnosis of bipolar I or II disorder who experienced a new-onset depressive episode were analyzed. Approximately 44% of patients had current or prior alcohol use, and 30% had a past or current drug use disorder. It was found that the likelihood of switching did not differ significantly between patients with prior SUDs and those with current SUDs. Therefore, the risk for direct switch in these patients was not induced or worsened by ongoing substance use.

An unexpected finding was that patients’ recovery time from a major depressive episode was not affected by whether patients had comorbid SUDs. Neither current nor prior substance use was thought to delay recovery from a depressive episode; therefore, patients did not suffer longer depressive episodes than patients without SUDs.

Lead researcher, Michael Ostacher, MD, MPH, of Massachusetts General Hospital and Harvard Medical School stated: “The results from this study suggest that treating patients with bipolar disorder for depression, even if they have a drug or alcohol problem, is no less successful than if they have no substance problem. This means that the standard guidelines for the treatment of bipolar disorder can be used for patients regardless of drug or alcohol problems.”

Defined as ≥4 mood episodes in the previous year, rapid cycling was more common in patients with prior or current alcohol use disorders, but had no significant correlation with prior or current drug use disorders. Based on these findings, the authors propose that patients with concomitant bipolar disorder and SUDs may have a set of inherent characteristics different from those of patients with bipolar disorder and no substance abuse.

“Patients with bipolar disorder and concomitant SUDs tend to be more ill. They are more likely to have attempted suicide, have more prior episodes, do not appear to function as well, are less likely to adhere to treatment, and are more likely to be violent,” explained Dr. Ostacher.

Regarding treatment of patients with SUDs, Dr. Ostacher added: “First, patients should be counseled to moderate or stop their use. Motivational interviewing techniques should be used to engage patients in a process of behavioral change, and referral for specialized treatment should be made. Treatments that are approved for drug or alcohol dependence should be used, especially considering the absence of data showing their ineffectiveness in comorbid bipolar disorder.”

Funding for this study was provided by the National Institute of Mental Health. (Am J Psychiatry. March 15, 2010 [Epub ahead of print]) –JV

Interpersonal Psychotherapy for Adolescent Girls at Risk for Adult Obesity

A recent study suggests that interpersonal psychotherapy (IPT) may help prevent weight gain and binge eating in adolescent girls at risk for adult obesity.

Marian Tanofsky-Kraff, PhD, at the Uniformed Services University of the Health Sciences in Maryland, and colleagues, evaluated the 1-year outcomes of IPT compared to general health education. Thirty-eight adolescent girls (12–17 years of age) at risk for adult obesity (body mass index in the 75th-97th percentile) were randomized to IPT or a health education group. Twenty of the 38 girls had out of control eating patterns at baseline.

According to previous studies, IPT can effectively reduce binge-eating behavior in obese adults and help stabilize the weight gain associated with binge eating. One goal of IPT is to demonstrate to patients the influences of social interaction, and especially negative social interaction. In this study, patients in the IPT group were encouraged to appreciate how their own spoken communication and, for example, body language, affects interaction with others. By moving toward more frequent positive social interactions, the goal was to lessen, or eliminate, any number of negative stimuli that might cause the patients to respond by eating.

Thirty-five patients returned to 1-year follow-up. Patients with out of control eating, who were in the IPT group, had greater reductions in those behaviors than those in the health education group (P=.036). Regardless of out of control eating status, IPT patients also showed greater weight stabilization at 1-year follow-up.

Funding for this study was provided by the National Institutes of Health and the Uniformed Services University of the Health Sciences. (Int J Eat Disord. Oct 30, 2009 [epub ahead of print]). –LS

Psychiatric dispatches is written by Christopher Naccari, Lonnie Stoltzfoos, and Jennifer Verlangieri.