The headline news is that it increased: the overall rate of people treated for some form of "depression" went from 2.37% to 2.88% per year. That's an increase of 21%, which is not trivial, but it's much less than the increase in the previous decade: it was just 0.73% in 1987.But the increase was concentrated in. some groups of people.
- Americans over 50 accounted for the bulk of the rise. Their use went up by about 50%, while rates in younger people stayed almost steady. In '98 the peak age band was 35-49, now it's 50-64, with almost 5% of those people getting treated in any given year.
- Men's rates of treatment went up by over 40% while women's only increased by 10%. Women are still more likely to get treated for depression than men, though, with a ratio of 1.7 women for each 1 man. But that ratio is a lot closer than it used to be.
- Black people's rates increased hugely, by 120%. Rates in black people now stand at 2.2% which is close behind whites at 3.2%. Hispanics are now the least treated major ethnic group at 1.9%: in previous studies, blacks were the least treated. (There was no data on Asians or others).
In terms of what treatments people got, out of everyone treated for depression, 80% got some kind of drugs, and that didn't change much. But use of psychotherapy declined a bit from 54% to 43% (some people got both).
What's also interesting is that the same authors reported last year that, over pretty much the same time period ('96 to '05), the number of Americans who used antidepressants in any given year sky-rocketed from 5% to 10% - that is to say, much faster than the rate of depression treatment rose! And the data are comparable, because they came from the same national MEPS surveys.
In other words, the decade must have seen antidepressants increasingly being used to treat stuff other than depression. What stuff? Well, all kinds of things. SSRIs are popular in everything from anxiety and OCD to premature ejaculation. Several of the "other new" drugs, like mirtazapine and trazodone, are very good at putting you to sleep (rather too good, some users would say...)
Marcus SC, & Olfson M (2010). National trends in the treatment for depression from 1998 to 2007. Archives of general psychiatry, 67 (12), 1265-73 PMID: 21135326
8 comments:
+1 on trazadone. Whats the point of Ambien when the best drug for sleeping has been on the market forever.
There's not been much research on the efficacy of trazadone, mirtazapine and amitriptyline (all very popular antidepressants used for sleep) compared to benzos and related compounds when used for insomnia, and there is some evidence that trazadone's effect may begin to wear off after a few weeks. They're also not licensed for that purpose.
I was being facetious, but thanks for the info. Theres no money to market them for that purpose now is there?
In my experience mirtazapine is much more sleep inducing than benzos. Benzos are relaxing, which can help you sleep, if you'd otherwise be kept awake by worries or something else, but they don't cause sleep per se. Whereas with mirtazapine, you can almost feel your brain trying to go to sleep with hypnogogic thoughts and hallucinations forcing their way into your mind if you try to stay awake.
After taking mirtazapine for over a year the sleep effects have become a lot weaker, but they're still there.
try trazadone.
Have not yet pulled the source article as I'm on (expletive) dial-up until storm damage here is repaired, and getting into uni from dial-up is... not pleasant.
I do wonder if some of the shift in coverage demographics is due to a major emphasis on primary care screening for depression (non-specific term) in federally qualified community health centers (also in Indian Health Service clinics). Funding for the CHCs, to a limited degree, comes based on participation in the 'collaborative' projects, which include chronic conditions such as diabetes and hypertension, and now include depression specifically. Using a PHQ-9 to screen for depressive symptoms, and then initiating treatment with an antidepressant as deemed appropriate by the GP, can be part of the outcome measures. As depressive symptoms (not broken out from major depressive disorder) are thought to worsen compliance to the management of the diabetes/HTN, they are targeted for management in these programs. CHCs see a fair number of people who are 50+ and on Medicare for disability rather than age. Ethnic makeup varies by region. I don't know if this article accounts for that, but I do know that the primary-care screening and (unfortunate phrase, sorry) shotgun management approach has been a major effort over at least the past 7 years. Unutzer et al.'s IMPACT work is being expanded more in this area and into this population, I believe.
The funding/support for the agencies hasn't included actual staff for psychotherapy; sometimes there is support for phone case management for some behavioral activation, but not for sufficient staff for things such as brief solution-focused therapy, ACT, etc.
Anyway, I'm sure that would be a smallish percent of the shift - although given the change in payer status for health coverage/loss of coverage, maybe not.
Silver: Thanks for the comments. I really know nothing about the mechanics of the US healthcare system, but that does sound very plausible...
I had to comment, "black people" makes me giggle lol.
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