PFPC Daily - December 2, 2004

Antidepressant Use By U.S. Adults Soars

Overall Surge in Prescription Drug Usage Comes Amid Questions of Cost
and Safety

Washington Post - December 3, 2004

By Shankar Vedantam

One in 10 American women takes an antidepressant drug such as Prozac,
Paxil or Zoloft, and the use of such drugs by all adults has nearly
tripled in the last decade, according to the latest figures on
American health released yesterday by the federal government.

Those numbers are among a broad array of changes in health and health
care use in the United States identified in the report. It confirmed
that prescription drug costs are soaring faster than any other area
of medical care as ever-increasing numbers of Americans take drugs
for psychiatric conditions, to lower their cholesterol, to control
asthma and for a wide range of other reasons.

In 2002, the latest year for which data were available, the total tab
for health care soared to $1.6 trillion -- of which prescription
drugs accounted for $162 billion, the report found. Drug costs rose
by 15 percent over the year before, driven by a combination of more
expensive medicines and increased use.

The report comes at a time when questions are growing about the costs
and safety of many prescription drugs. The Food and Drug
Administration recently concluded that antidepressants can increase
the risk of suicidal behavior among children, and the manufacturer of
Vioxx abruptly recalled the popular painkiller for safety reasons. A
senior FDA official testified in Congress last month that he believes
five other approved drugs are dangerous and should be taken off the
market.

Antidepressant drugs called selective serotonin reuptake inhibitors
(SSRIs) showed some of the largest increases in use, the report said.
By 2000, the proportion of adults using such drugs had nearly
tripled, compared with the data set that ended in 1994.

In 2002, more than one in three doctor's office visits by women
involved a prescription for an antidepressant, said Amy Bernstein,
project director for the report issued by the Center for Mental
Health Services of the Centers for Disease Control and Prevention.

"It gives you an idea of what is happening during these visits," said
Bernstein, who explained that the statistic included patients already
on the drugs and those getting a new prescription.

The number of children getting psychiatric drugs also soared. In
2002, about 6 percent of all boys and girls were taking
antidepressants, triple the rate in the period 1994-96. And about 14
percent of boys -- nearly one in seven -- were on stimulant drugs in
2002, double the number in 1994-96, the report found. Stimulant drugs
are usually used to treat attention deficit disorder.

The number of adults taking cholesterol-lowering statin drugs nearly
quadrupled from 1995-96 to 2001-02, the report found.

Overall, 44 percent of all Americans, including children, were taking
at least one prescription drug in 1999-2000, a statistically
significant 5 percent increase since 1994. The proportion taking
three or more prescription drugs increased from 12 to 17 percent
during that same time, Bernstein said.

"Factors affecting the recent increase in utilization of medications
include the growth of third-party insurance coverage for drugs, the
availability of successful new drugs, marketing to physicians and
increasingly directly to consumers, and clinical guidelines
recommending increased utilization of medications for conditions such
as high cholesterol, acid-reflux disease, and asthma," the report
concluded.

Julie Zito, a pharmaco-epidemiologist at the University of Maryland
at Baltimore, said it is difficult to characterize as good or bad the
increased use of drugs without studies that ask how people are faring
as a result.

"As the numbers keep growing year after year after year, and larger
proportions of the population appear to be suffering from conditions
or getting treatments they may or may not be benefiting from, that
would be an argument to follow large cohorts of patients in community
studies to assess effectiveness and safety," she said.

The drug industry's umbrella trade group said the increased use of
medications is a good thing.

"We have more medicines and better medicines for more diseases, and
patients are being more effectively treated," said Jeff Trewhitt, a
spokesman for the Pharmaceutical Research and Manufacturers of
America. "They are living longer largely because of new treatments,
and that is good news."

Trewhitt said there are numerous examples of how increased use of
drugs -- such as cholesterol-lowering statins -- reduce overall
health care costs by controlling heart disease and reducing more
expensive hospitalizations.

On the increase in antidepressant use, Trewhitt said, "I don't know
how to read that. We just don't have any information -- it's not
something we have studied."

SOURCE:
http://www.washingtonpost.com/