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Trends in Antidepressant Utilization From 2001 to 2004

Dr. Harman is with the Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, 101 S. Newell Dr., Room 4151, P.O. Box 100195, Gainesville, FL 32611-0195 (e-mail: jharman{at}phhp.ufl.edu). Dr. Edlund is with the Department of Psychiatry, University of Arkansas for Medical Sciences (UAMS), Little Rock. Dr. Fortney is with the South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, and with the UAMS Department of Psychiatry.

OBJECTIVE: This study investigated whether the trend of increasing rates of antidepressant use in the 1990s continued into 2000–2004. Antidepressant treatment rates were examined by age group and by the class of antidepressant in order to identify whether any observed trends were being driven by a particular age group of patients or class of medication. METHODS: Secondary analysis was performed on data from the 2000–2004 Medical Panel Expenditure Surveys, a nationally representative survey of U.S. households, to examine trends in antidepressant use by age group and medication class in the total sample (N=166,435). Trends in the rates of antidepressant use among individuals with self-reported depression (N=10,959) and self-reported anxiety disorders without comorbid depression (N=6,899) were also examined. RESULTS: Antidepressant use increased among all Americans, from 6.6% in 2000 to 8.1% in 2004 (p<.001). Rates of antidepressant use by individuals with anxiety disorders without comorbid depression increased from 30.8% in 2000 to 39.0% in 2002, before declining to 33.2% in 2004. However, antidepressant use decreased among individuals with self-reported depression, from 63.1% in 2000 to 56.7% in 2004 (p<.001). This downward trend in antidepressant use was largely driven by a decrease in use of selective serotonin reuptake inhibitors, especially among children and middle-aged adults with depression. Rates of adequate antidepressant treatment (defined as receiving at least four antidepressant prescriptions at the minimum adequate daily dosage) peaked in 2002 (36.9%), and there was a significant decline by 2004 (31.7%) (p=.003). CONCLUSIONS: After years of increased use of antidepressant therapy to treat depression, a trend reversal in the beginning of the 21st century was observed, including decreasing rates of adequate antidepressant treatment. This downward trend preceded the black-box warnings included on antidepressant labels beginning in 2004.

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