Patients becoming more aware that drugs safe, effective for psychological, behavioral disorders

March 1, 2012

The increase in utilization of medications for psychological and behavioral disorders can be attributed to greater awareness among patients that mental health disorders are treatable and that available drug therapies are safe and effective, according to David Muzina, MD, a national practice leader of the Medco Neuroscience Therapeutic Resource Center.

The increase in utilization of medications for psychological and behavioral disorders can be attributed to greater awareness among patients that mental health disorders are treatable and that available drug therapies are safe and effective, according to David Muzina, MD, a national practice leader of the Medco Neuroscience Therapeutic Resource Center.

The report is an analysis of the trends in mental health-related medication usage among the insured population. The research included a review of prescription drug claims of more than 2 million Americans to assess mental health drug treatments from 2001 to 2010.

"For mood and anxiety disorders, it is generally accepted that women are more susceptible to these problems," Dr. Muzina told Formulary. "Women, however, are more likely to seek help than men to talk about emotional health issues with their healthcare provider."

TRENDS IN ANTIDEPRESSANT USE

Middle-aged and elderly women use antidepressants at a much higher rate than men. In 2010, 23% of women aged 45 to 64 were treated with medication for depression compared with only 11% of men who were the same age. In the elderly population, 24% of women aged 65 or older were prescribed antidepressants compared with 13% of men. The most commonly prescribed class of antidepressants was selective serotonin reuptake inhibitors (SSRIs).

"Speaking as a practicing psychiatrist, most psychiatrists believe that [SSRIs] are the safest and most effective class of antidepressant medications. However, there is not a lot of great head-to-head research that compared an SSRI to an older antidepressant and even some of the newer drugs that are not SSRIs," explained Dr Muzina.

"SSRIs certainly are pretty easy to dose, generally once a day. Side effects tend to be minimal. If they are present, they are only for the first few weeks of treatment. So in practice, they are accepted as first-line therapy," he continued.

Children's use of antidepressants peaked in 2004 and then declined to 2001 levels by 2010, which correlated with the FDA issuance of a black box warning in 2004 about the potential increased risk of suicidality in children taking these medications. About 2.5% of girls and 2.1% of boys used antidepressants in 2010, according to the report.

"The FDA warning caused physicians to think twice before starting a kid on an antidepressant and perhaps try non-medication approaches for a while before making a decision to start a medication," Dr Muzina said.

Nonadherence to antidepressant therapy was highlighted in a study presented at the 2010 American Psychiatric Association annual meeting. Almost one-third of patients who were prescribed an increase in the dosage of antidepressant medication were not adherent to their original prescriptions.

"If the patient is starting and stopping and missing doses, he or she may be more likely to have recurrent or chronic side effects. So it is a major challenge in the therapeutic treatment of these disorders such as depression and anxiety with antidepressant drugs," Dr Muzina noted.

DRUG USAGE FOR ANXIETY DISORDERS

Approximately 40 million American adults have an anxiety disorder, but only about one-third of them are treated for this mental health condition. Benzodiazepines are often prescribed to treat general anxiety, panic disorder, and social phobias. The highest rate of utilization was among middle-aged women in 2010, with approximately 11% being treated compared to only 5.7% of middle-aged men.

The America's State of Mind Report also noted that the percentage of older Americans prescribed this category of drugs declined 44% from 2001 to 2010. The elderly may be at increased risk of memory impairment, balance problems, confusion, and a loss of inhibitions when taking anti-anxiety drugs. In 2007, FDA reinforced these conclusions with additional safety labeling information for the benzodiazepine lorazepam. However, the main reasons for a decline in use of these medications can be directly attributed to Medicare Part D enactment and the loss of coverage for these medications.

Dr Muzina believes that the elderly are still being prescribed anti-anxiety medications, but are paying for them out-of-pocket as they are inexpensive. Therefore, the report, which is based on prescription claims, does not reflect the actual usage of these medications.

ADHD TREATMENTS

The Medco report showed that boys were the most prevalent users of drugs for treating ADHD, but more girls are also being treated for the condition, with an increase of 40% in 2010 compared to a decade ago. Approximately 5.4 million children aged 4 to 17 years have received a diagnosis for ADHD and more parents of these children are also being diagnosed, according to the Centers for Disease Control and Prevention.

Over the period of 2001 to 2010, adult women aged 20 to 44 have seen a spike in ADHD diagnosis and treatment, up 264% compared to 188% rise in adult men of the same age range. "This could be attributed to the fact that women are now aware of the inattentive symptoms associated with ADHD that they have had for a long time and they recognize this is something that they can get help for," Dr Muzina said.

ATYPICAL ANTIPSYCHOTICS

Atypical antipsychotics, known as second-generation antipsychotics, are the replacements to the traditional drugs for treatment of schizophrenia and its related disorders. The mostly widely used antipsychotics include aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), paliperidone (Invega), risperidone (Risperdal), and ziprasidone (Geodon). A number of these drugs are now available as generics.

The use of atypical antipsychotics has risen since 2001 among adults and children. Adults aged 20 to 64 in 2010 were treated at a rate of 3.5 times more than a decade ago. Men aged 20 to 64 had a higher increase than women where their usage of these medications quadrupled from 2001 to 2010. Older adults aged 65 and up have the highest use of these therapies overall.

More education is needed about the risks of treating the elderly who have dementia with atypical antipsychotics, because in this population there is an increased mortality risk. In addition, children and their parents need to be warned about the risk of diabetes and metabolic disorders that can occur with the use of these medications.

Psychiatrists and primary care physicians both prescribe atypical antipsychotics and can do a better job about explaining the risks associated with these medications, Dr Muzina said.