Overmedicated, Undermedicated?

It appears to depend on who you are (and who you ask), according to two papers in the January 2010 issue of Archives of General Psychiatry. According to the press releases:

More US patients receive multiple psychotropic medications

An increasing number of U.S. adults are being prescribed combinations of antidepressants and antipsychotic medications...

. . .

To examine patterns and trends in psychotropic polypharmacy—or the prescription of more than one psychiatric medication—[Mojtabai & Olfson, 2010] analyzed data collected from a national sample of office-based psychiatry practices. The number of medications prescribed and specific medication combinations were assessed from a total of 13,079 office visits to psychiatrists by adults (18 years or older) between 1996 and 2006.

. . .

"The increasing trend of psychotropic polypharmacy was mostly similar across visits by different patient groups and persisted after controlling for background characteristics," the authors write. Combinations of antidepressants with sedative-hypnotics were the most common medication combinations overall (23.1 percent), followed by combination of antidepressants with antipsychotics (12.9 percent) and combinations of two types of antidepressants (12.6 percent).

"While the evidence for added benefit of antipsychotic polypharmacy is limited, there is growing evidence regarding the increased adverse effects associated with such combinations," the authors write.

On the other hand...

Half of depressed Americans go untreated...

Antidepressants under-prescribed, particularly among minorities

. . .

The majority of treated patients, nearly 45 percent, received psychotherapy with no medication. Only 34 percent of patients were prescribed antidepressants. Of that number, Mexican Americans and African Americans were prescribed antidepressants a third less often than Caucasians. Factors such as education, health insurance and income did not explain the lower rates of medication use.

...and:

Few Americans with major depression receive adequate treatment

Many U.S. adults with major depression do not receive treatment for depression or therapy based on treatment guidelines, and some racial and ethnic groups have even lower rates of adequate depression care...

. . .

[González et al., 2010] assessed the prevalence and adequacy of depression care among different racial and ethnic groups in the United States by analyzing data from the National Institute of Mental Health's Collaborative Psychiatric Epidemiology Surveys. This initiative combines three nationally representative studies, during which face-to-face interviews were conducted with 15,762 individuals age 18 and older throughout the country between 2001 and 2003.

Of the adults surveyed, 8.3 percent had major depression, including 8 percent of Mexican Americans, 11.8 percent of Puerto Ricans, 7.9 percent of Caribbean blacks, 6.7 percent of African Americans and 8.5 percent of non-Latino whites.

Overall, more than half of those with depression received at least one form of depression care, but only about one in five (21.3 percent) had received at least one form of therapy that conformed to established treatment guidelines within the previous year.

Perhaps Neuroskeptic will have more to say about this...

References

González HM, Vega WA, Williams DR, Tarraf W, West BT, Neighbors HW (2010). Depression Care in the United States: Too Little for Too Few. Arch Gen Psychiatry 67:37-46.

Mojtabai R, Olfson M (2010). National Trends in Psychotropic Medication Polypharmacy in Office-Based Psychiatry. Arch Gen Psychiatry 67:26-36.