The report is based on 2013 government survey data on some 37,421 adults and provides the finest-grained snapshot of prescription drug use for psychological and sleep problems to date.
"I follow this area, so I knew the numbers would be high," said Thomas J. Moore, a researcher at the Institute for Safe Medication Practices, a nonprofit in Alexandria, Va., and the lead author of the analysis, which was published Monday in JAMA Internal Medicine. "But in some populations, the rates are extraordinary."
Mr. Moore and his co-author, Donald R. Mattison of Risk Sciences International in Ottawa, combed household survey and insurance data compiled by the federal Agency for Healthcare Research and Quality. They found that one in five women had reported filling at least one prescription that year - about two times the number of men who had - and that whites were about twice as likely to have done so than blacks or Hispanics.
Nearly 85 percent of those who had gotten at least one drug had filled multiple prescriptions for that drug over the course of the year studied, which the authors considered long-term use. "To discover that eight in 10 adults who have taken psychiatric drugs are using them long term raises safety concerns, given that there's reason to believe some of this continued use is due to dependence and withdrawal symptoms," Mr. Moore said.
Dr. Mark Olfson, a professor of psychiatry at Columbia University, who was not involved in the study, said the new analysis provided a clear, detailed picture of current usage: "It reflects a growing acceptance of and reliance on prescription medications" to manage common emotional problems, he said.
The most commonly used type of drug was an antidepressant like Zoloft and Celexa, followed by an anti-anxiety or sleeping pill like Xanax and Ambien. All of these drugs can have withdrawal effects, including panic attacks and sleep problems, for many people on them long term. The prescribing of most anti-anxiety pills is strongly regulated in this and other countries because the drugs can be habit forming.
Usage rates were also higher with increased age, with one in four people of retirement age reporting at least one prescription. This is a growing concern among some doctors, as the incidence of diagnosable mental problems, with the exception of insomnia, tends to be much lower in elderly people than in young adults.
The increased rates in this group are most likely due in part to the fact that most elderly people get psychiatric drugs from their primary care doctor, who often prescribe for episodic conditions like mild depression and insomnia. "Particularly for this group, we need to be mindful of the trade-offs in prescribing," Dr. Olfson said. "These are not benign drugs."
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