About one in six U.S. adults reported taking one or more psychiatric drugs in 2013, and many report long-term use, according a research letter published Monday in JAMA Internal Medicine.

The study was based on data from the 2013 Medical Expenditure Panel Survey, which included 357,432 prescription records for 37,421 adults ages 18 to 85. The researchers used the survey's multistage probability design to estimate population percentages. Researchers analyzed individuals' use of three classes of psychiatric drugs:

• Antidepressants;
• Anxiolytics, sedatives, and hypnotics; and
• Antipsychotics.

Findings

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Overall, the researchers estimated that 16.7 percent of the 242 million adults in the United States filled at least one psychiatric drug in 2013, including:

• 12 percent who reported filling one or more prescriptions for antidepressants;
• 8.3 percent who reported filling one or more prescriptions for sedatives, hypnotics, and anxiolytics; and
• 1.6 percent who reported filling one or more prescriptions for antipsychotics.

According to the research letter, the rates at which individuals reporting filling prescriptions for psychiatric drugs varied by race and ethnicity. The researchers found that:

• 20.8 percent of white adults reported using psychiatric drugs;
• 9.7 percent of black adults reported using psychiatric drugs;
• 8.7 percent of Hispanic adults reported using psychiatric drugs; and
• 4.8 percent of Asian adults reported using psychiatric drugs.

Further, the researchers found that the rate of psychiatric drug use increased by age. According to the study, 25.1 percent of adults ages 60 to 85 used at least one psychiatric drug, compared with 9 percent of those ages 18 to 39. The researchers also found that older adults were more likely to use antidepressants and anxiolytics, sedatives, and hypnotics, but not antipsychotics.

In addition, the researchers found that women were more likely than men to report using psychiatric drugs, at 21 and 12 percent, respectively.

According to the research letter, most individuals who reported using psychiatric drugs said they used the medications long-term. The researchers found that 84.3 percent of adults filled three or more prescriptions for psychiatric drugs in 2013 or reported that they had started to take the drugs in 2011 or earlier. Long-term psychiatric drug users filled a mean of nearly 10 prescriptions for the drugs in 2013.

Comments

Research letter co-author Thomas Moore of the Institute for Safe Medication Practices called the rates of psychiatric drug use in some populations "extraordinary." He added, "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."

Moore and research letter co-author Donald Mattison of Risk Sciences International concluded, "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" (Carey, New York Times, 12/12; Duggal, MedPage Today, 12/12; Fox, NBC News, 12/12; Scutti, CNN, 12/12; Welch, CBS News, 12/12; Moore/Mattison, JAMA Internal Medicine, 12/12).

Six steps to integrate behavioral health with other care

Behavioral health issues can exacerbate other health conditions and make patients less likely to comply with important care plan aspects. Since most patients are diagnosed in the primary care setting, integrated behavioral health models can ensure patients follow through with referrals to mental health care.

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