Questions for Laura Pratt, Psychiatric Epidemiologist and Author of “Antidepressant Use in Persons Aged 12 and Over: United States, 2011-2014”
Q: Are more people taking antidepressants now vs. in the past?
LP: Yes, in our data brief, figure 4, you can see how antidepressant use has increased over time from 1999-2002 to 2011-2014. Slightly less than 8% of the U.S. population took antidepressants in 1999-2002 while almost 13% took antidepressants in 2011-2014. This is an increase of about 65%. The rates of increase were similar for males and females, but twice as many females took antidepressants as males at all time points.
Q: Is there any particular age group in which antidepressant use is higher?
LP: Among all persons and among females, antidepressant use was highest in persons 60 years of age and older.
Q: Does this mean that rates of mental illness are on the rise?
LP: Our report does not look at rates of mental illness. But in general, prescription drug use is also related to healthcare access and utilization, and, in mental health particularly, many studies have shown high rates of under-treatment. The situation with a large percent of people with depression, for example, not receiving treatment has improved over time. Increases in healthcare utilization and treatment of depression would result in a higher rate of antidepressant use whether or not the rates of mental illness increased.
Q: What are the risks or dangers of antidepressant use?
LP: The first antidepressants that were available had many side effects and could cause overdose death. The vast majority of overdose deaths related to these drugs were intentional (suicides). The newer antidepressants in use today have fewer side effects and have a much lower risk of overdose. Antidepressants do not produce a “high” and are not drugs of abuse.
Q: Any other findings you feel are noteworthy?
LP: It was very noteworthy that non-Hispanic white persons ages 12 and older continue to have rates of antidepressant use that are between 3 and 5 x higher than persons in other race and Hispanic origin groups. I was also surprised to see that 25% of people who take an antidepressant have taken it for more than 10 years. In our first antidepressant data brief, the percent of people taking an antidepressant for more than 10 years was 13.6%. Interestingly, the percent of persons taking antidepressants who took them for more than 2 years was 61% in 2005-08 and increased to 68% in 2011-2014.
Questions for Margaret Warner, Senior Epidemiologist and Lead Author on “Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2010–2014.”
Q: Why did you decide to do a report on drugs most frequently involved in drug overdose deaths?
MW: From our routine mortality statistics, we know that drug overdose death rates are increasing, and we have some insight into the classes of drugs involved. This report presents findings from a new method we developed to identify the specific drugs involved in drug overdose deaths, which gives us a more complete and granular understanding of the problem.
Q: Do you have 2015 data on drug overdose deaths? If not, when do you anticipate this being released?
MW: NCHS just released the 2015 mortality data at the beginning of December. CDC released an MMWR last week describing drug overdose deaths in 2015 and some of the drug classes involved. NCHS is currently analyzing the 2015 literal text data using the new method to report on the specific drugs, and plan to have those results available soon.
Q: How has the number of drug overdose deaths changed from 2010 to 2014?
MW: From 2010 through 2014, the number of drug overdose deaths per year increased 23%. During this 5-year period, the age-adjusted rate of drug overdose deaths involving heroin more than tripled, and the rate of drug overdose deaths involving methamphetamine more than doubled.
The rate of drug overdose deaths involving fentanyl more than doubled in a single year (from 2013 to 2014). Fentanyl went from the 9th most common drug involved in overdose deaths in 2013 to the 5th most common in 2014.
Q: What are the most prevalent drugs involved in drug overdose deaths?
MW: The 10 drugs most frequently involved in overdose deaths included the following opioids: heroin, oxycodone, fentanyl, morphine, methadone, and hydrocodone; the following benzodiazepines: alprazolam and diazepam; and the following stimulants: cocaine and methamphetamine.
Q: Were there any findings that surprised you?
MW: We suspected that multidrug toxicity played a role in drug overdose deaths, and this analysis revealed that nearly half of these deaths where at least one drug was mentioned on the death certificate, involved more than one drug. We were surprised that the top 10 drugs were often mentioned in combination with each other. We were also pleasantly surprised to find that the reporting on specific drugs improved with the percentage of death certificates mentioning at least one specific drug increasing from 67% in 2010 to 78% in 2014.
Poisoning is the leading cause of injury-related mortality in the United States, with more than 40,000 deaths annually. Drugs account for 90% of poisoning deaths, and the number of deaths from drug poisoning has increased substantially in recent years. The emergency department (ED) plays an important role in the treatment of poisoning.
A new NCHS report describes nationally representative data on ED visits for drug poisoning during 2008–2011.
Key Findings from the Report:
- During 2008–2011, an average of 1.1 million emergency department (ED) visits were made each year for drug poisoning, with a visit rate of 35.4 per 10,000 persons.
- The ED visit rate for drug poisoning was highest among persons aged 20–34. The rate declined with age after 20–34, and rates for those aged 0–19 were similar to those aged 50 and over.
- Drug-poisoning ED visit rates did not differ by sex and age, with the exception of persons aged 35–49, where females had a higher visit rate than males. The ED visit rate for unintentional drug poisoning was higher than self-inflicted drug poisoning overall and for males, but did not differ for females.
- About one-quarter (24.5%) of drug-poisoning ED visits resulted in hospital admission.
Approximately one-fifth (18%) of the $263 billion spent on retail prescription drugs in the United States in 2012 was paid out of pocket. Some adults offset the cost of prescription drugs by reducing the dosage and frequency of the recommended pharmacotherapy. Other cost-saving strategies include asking providers for less-expensive medications or purchasing medications abroad.
A new NCHS report updates previously reported estimates for strategies used by U.S. adults aged 18 and over to reduce their prescription drug costs, using data from the 2013 National Health Interview Survey.
Key Findings from the Report:
- To save money, almost 8% of U.S. adults (7.8%) did not take their medication as prescribed, 15.1% asked a doctor for a lower-cost medication, 1.6% bought prescription drugs from another country, and 4.2% used alternative therapies.
- Adults aged 18–64 (8.5%) were nearly twice as likely as adults aged 65 and over (4.4%) to have not taken their medication as prescribed to save money.
- Among adults aged 18–64, uninsured adults (14.0%) were more likely than those with Medicaid (10.4%) or private coverage (6.1%) to have not taken their medication as prescribed to save money.
- The poorest adults—those with incomes below 139% of the federal poverty level—were the most likely to not take medication as prescribed to save money.
In 2011, Americans spent $45 billion out-of-pocket on retail prescription drugs. Some adults reduce prescription drug costs by skipping doses and delaying filling prescriptions; however, some cost-reduction strategies used by adults have been associated with negative health outcomes. For example, adults who do not take prescription medication as prescribed have been shown to have poorer health status and increased emergency room use, hospitalizations, and cardiovascular events
A new report from NCHS analyzes different strategies used by U.S. adults to reduce their prescription drug costs, by age, health insurance status, and poverty status, using data from the 2011 National Health Interview Survey.
Key findings from the report:
- Adults aged 18–64 and those aged 65 and over were equally likely to have asked their doctor for a lower-cost medication to save money on prescription drugs (19.8% and 20.3%, respectively).
- Adults aged 18–64 were twice as likely to not have taken medication as prescribed to save money (12.6%) compared with adults aged 65 and over (5.8%).
- Among adults aged 18–64, uninsured adults (23.1%) were more likely than those with Medicaid (13.6%) or those with private coverage (8.7%) to not have taken medication as prescribed to save money.
- Among adults aged 65 and over, those with only Medicare coverage were more likely to ask their doctor for a lower-cost medication to save money (24.9%) compared with those who had private coverage (20.1%) and those with Medicare and Medicaid (14.7%) coverage.
Surprisingly, only a third of the people with severe psychological symptoms actually take antidepressant medication. Despite this fact, antidepressants are still the third most commonly prescribed drug taken by Americans of all ages. From 2005-2008, cholesterol-lowering drugs and analgesics, also known as painkillers, were the top two most prescribed drugs, with antidepressants following closely behind. A recent report on Antidepressant use in persons 12 and older: United States, 2005-2008 found that 11% of Americans 12 and over take antidepressants, of these people, over half have taken them for two or more years.
Non-Hispanic whites are more likely to take antidepressant medication than people of other races, although there was no difference in the usage of these types of medication based on income. Women were also more likely to take medication for severe depressive symptoms, about 40%. Many people take more than one antidepressant, although this study did not provide any data on how many medications taken per person.
Seeing a mental health professional is critical in tracking depression; the more drugs prescribed to a person, the more likely it is that they have seen a mental health professional in the past year. However, less than one third of persons taking just one antidepressant have seen a mental health professional in the past year. The data found in this study brings about many questions. How many people out there are in need of medication, yet refuse, or are unable, to get help? What are the long term effects of taking antidepressants in teenagers? And perhaps most importantly, why are there so many people taking antidepressants?
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