Source: Washington Post
Date: 3 December 2004

Antidepressant Use By U.S. Adults Soars
Cost and Risk Questions Mount in Face Of Overall Surge in Prescription Drugs

By Shankar Vedantam
Washington Post Staff Writer

One in 10 American women takes an antidepressant drug such as Prozac, Paxil or Zoloft, and the use of such drugs by all adults has nearly tripled in the last decade, according to the latest figures on American health released yesterday by the federal government.

Those numbers are among a broad array of changes in health and health care use in the United States identified in the report. It confirmed that prescription drug costs are soaring faster than any other area of medical care as ever-increasing numbers of Americans take drugs for psychiatric conditions, to lower their cholesterol, to control asthma and for a wide range of other reasons.

In 2002, the latest year for which data were available, the total tab for health care soared to $1.6 trillion -- of which prescription drugs accounted for $162 billion, the report found. Drug costs rose by 15 percent over the year before, driven by a combination of more expensive medicines and increased use.

The report comes at a time when questions are growing about the costs and safety of many prescription drugs. The Food and Drug Administration recently concluded that antidepressants can increase the risk of suicidal behavior among children, and the manufacturer of Vioxx abruptly recalled the popular painkiller for safety reasons. A senior FDA official testified in Congress last month that he believes five other approved drugs are dangerous and should be taken off the market.

Antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) showed some of the largest increases in use, the report said. By 2000, the proportion of adults using such drugs had nearly tripled, compared with the data set that ended in 1994.

In 2002, more than one in three doctor's office visits by women involved a prescription for an antidepressant, said Amy Bernstein, project director for the report issued by the Center for Mental Health Services of the Centers for Disease Control and Prevention.

"It gives you an idea of what is happening during these visits," said Bernstein, who explained that the statistic included patients already on the drugs and those getting a new prescription.

The number of children getting psychiatric drugs also soared. In 2002, about 6 percent of all boys and girls were taking antidepressants, triple the rate in the period 1994-96. And about 14 percent of boys -- nearly one in seven -- were on stimulant drugs in 2002, double the number in 1994-96, the report found. Stimulant drugs are usually used to treat attention deficit disorder.

The number of adults taking cholesterol-lowering statin drugs nearly quadrupled from 1995-96 to 2001-02, the report found.

Overall, 44 percent of all Americans, including children, were taking at least one prescription drug in 1999-2000, a statistically significant 5 percent increase since 1994. The proportion taking three or more prescription drugs increased from 12 to 17 percent during that same time, Bernstein said.

"Factors affecting the recent increase in utilization of medications include the growth of third-party insurance coverage for drugs, the availability of successful new drugs, marketing to physicians and increasingly directly to consumers, and clinical guidelines recommending increased utilization of medications for conditions such as high cholesterol, acid-reflux disease, and asthma," the report concluded.

Julie Zito, a pharmaco-epidemiologist at the University of Maryland at Baltimore, said it is difficult to characterize as good or bad the increased use of drugs without studies that ask how people are faring as a result.

"As the numbers keep growing year after year after year, and larger proportions of the population appear to be suffering from conditions or getting treatments they may or may not be benefiting from, that would be an argument to follow large cohorts of patients in community studies to assess effectiveness and safety," she said.

The drug industry's umbrella trade group said the increased use of medications is a good thing.

"We have more medicines and better medicines for more diseases, and patients are being more effectively treated," said Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America. "They are living longer largely because of new treatments, and that is good news."

Trewhitt said there are numerous examples of how increased use of drugs -- such as cholesterol-lowering statins -- reduce overall health care costs by controlling heart disease and reducing more expensive hospitalizations.

On the increase in antidepressant use, Trewhitt said, "I don't know how to read that. We just don't have any information -- it's not something we have studied."

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