Limited public information is available about the extent of the use of psychiatric drugs among the US adult population. The Substance Abuse and Mental Health Services Administration used the Survey on Drug Use and Health to estimate that 11.5% of adults reported taking prescription medication for “problems with emotions, nerves, or mental health” in 2011.1(p92) However, the survey excerpt does not provide information on which specific medications were more commonly used or on estimated duration of use. We sought to characterize adult use of psychiatric drugs in the United States using publicly available, nationally representative data and explore differences by sex, age, and race/ethnicity.
We used the 2013 Medical Expenditure Panel Survey2 to calculate percentages of the adult population aged 18 to 85 years using 3 classes of psychiatric drugs: (1) antidepressants; (2) anxiolytics, sedatives, and hypnotics; and (3) antipsychotics. Our psychiatric drug categories followed the survey’s Multum Lexicon therapeutic class scheme,3 except that we included all benzodiazepines as anxiolytics, sedatives, and hypnotics, including those classified as anticonvulsants. Population percentages and 95% CIs were calculated from the survey’s multistage probability design, with 327 557 unweighted prescription records from a sample of 36 940 individuals. Long-term use was defined as 3 or more prescriptions filled in 2013 or a prescription started in 2011 or earlier. Logistic regression was used to compute odds ratios (ORs) to investigate differences by subcategories of sex, race/ethnicity, and age. The government survey data were publicly available and deidentified, and therefore institutional review board approval was not required.
Overall, 16.7% (95% CI, 15.9%-17.5%) of 242 million US adults reported filling 1 or more prescriptions for psychiatric drugs in 2013, including 12.0% (95% CI, 11.3%-12.7%) reporting antidepressants; 8.3% (95% CI, 7.7%-8.9%) filling prescriptions for anxiolytics, sedatives, and hypnotics; and 1.6% (95% CI, 1.4%-1.8%) taking antipsychotics. Table 1 highlights differences by sex, age, and race/ethnicity. Large differences were found in race/ethnicity, with 20.8% of white adults reporting use vs 8.7% of Hispanic adults (OR, 3.1; 95% CI, 2.7-3.5). Rates for blacks and Asian adults were also lower than those for white adults, but not statistically significantly different from Hispanic adults. Use of psychiatric drugs also increased with age with 25.1% of adults aged 60 to 85 years compared with 9.0% of those aged 18 to 39 years (OR, 3.4; 95% CI 3.0-3.9). Women were more likely than men to report taking psychiatric drugs (OR, 2.0; 95% CI, 1.8-2.2). For antipsychotics, there was little variation in exposure by any demographic subgroup. The 10 most frequently used psychiatric drugs are shown in Table 2.
Most psychiatric drug use reported by adults was long term, with 84.3% (95% CI, 82.9%-85.7%) having filled 3 or more prescriptions in 2013 or indicating that they had started taking the drug during 2011 or earlier. Differences in long-term use among the 3 drug classes were small. The long-term users filled a mean (SE) of 9.8 (0.19) prescriptions for psychiatric drugs during 2013.
These data show 1 of 6 US adults reported taking psychiatric drugs at least once during 2013, but with 2- to 3-fold differences by race/ethnicity, age, and sex. Moreover, use may have been underestimated because prescriptions were self-reported, and our estimates of long-term use were limited to a single survey year.
Among adults reporting taking psychiatric drugs, more than 8 of 10 reported long-term use. Prescribing information for the leading antidepressants includes limited information about appropriate duration of treatment. However, benzodiazepines have warnings about drug dependence, tolerance, withdrawal, and rebound symptoms.4 In a previous study,5 we found most patients were long-term users of the hypnotic zopidem tartrate despite recommendations for short-term use, and many were combining it with other central nervous system depressants despite warnings. Safe use of psychiatric drugs could be improved by increasing emphasis on prescribing these agents at the lowest effective dose and systematically reassessing the need for continued use.
Corresponding Author: Thomas J. Moore, AB, Institute for Safe Medication Practices, 101 N Columbus St, Ste 410, Alexandria, VA 22314 (tmoore@ismp.org).
Correction: This article was corrected online March 6, 2017, to fix an error in the Methods section.
Published Online: December 12, 2016. doi:10.1001/jamainternmed.2016.7507
Author Contributions: Mr Moore had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Both authors.
Acquisition, analysis, or interpretation of data: Both authors.
Drafting of the manuscript: Moore.
Critical revision of the manuscript for important intellectual content: Mattison.
Statistical analysis: Both authors.
Conflict of Interest Disclosures: None reported.
1.Substance Abuse and Mental Health Services Administration. Behavioral Health, United States, 2012. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013.
4.Xanax (Alprazolam) [package insert]. New York, NY: Pharmacia & Upjohn Co; 2013.