Antipsychotic Prescribing for MDD Patients: Recent Trends Examined

The rate of prescribing an antipsychotic medication to treat MDD increased from 18.5% in 2006-2007 to 24.9% in 2008-2009
The rate of prescribing an antipsychotic medication to treat MDD increased from 18.5% in 2006-2007 to 24.9% in 2008-2009

Results of a recent pharmacoepidemiologic analysis observed an increase, then a decrease, in the prescribing rate of antipsychotic medications for the treatment of unresponsive major depressive disorder (MDD) between 2006 and 2015.

To estimate the rates of antipsychotic medication prescribing for the treatment of MDD, researchers analyzed data from the 2006-2015 National Ambulatory Medical Care Survey (n=4,044). Clinical and demographic factors that were independently associated with the use of antipsychotic medications in MDD were identified using multivariable logistic regression analysis.

The authors reported that approximately one-fifth of adult patients with MDD were treated with an antipsychotic medication between 2006 and 2015. The rate of prescribing an antipsychotic medication to treat MDD increased from 18.5% in 2006-2007 to 24.9% in 2008-2009. This increase was then followed by a decline in the prescribing rate of antipsychotics in 2014-2015 (18.9%). Additionally, visits with patients ≥75 years old decreased from 27.0% in 2006-2007 to 10.7% in 2014-2015 (OR for overall trend: 0.73; 95% CI: 0.56, 0.95). 

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The study authors stated that, “Antipsychotic prescription was associated with being black or Hispanic, having Medicare among adults under 65 years or Medicaid as a primary source of payment, and receiving mental health counseling, 3 or more concomitant medications, and diagnosis of cannabis use disorder (P<0.01).” Aripiprazole, olanzapine, quetiapine, and risperidone were reported as the most commonly prescribed antipsychotic medications.

Pharmacoepidemiologic analysis determined that the rate of antipsychotic medication prescribing for the treatment of MDD first increased and then declined between 2006 and 2015. The authors hypothesized that concern surrounding the adverse effects of these medications in the elderly may have affected prescribing trends. They added, “Future research should track evolving trends following the publication of evidence of greater long-term effectiveness of antipsychotic than antidepressant next-step therapy in adults with MDD.”

Reference

Rhee, TG et al. Antipsychotic Prescriptions Among Adults With Major Depressive Disorder in Office-Based Outpatient Settings: National Trends From 2006 to 2015. J Clin Psychiatry 2018;79(2):17m11970
10.4088/JCP.17m11970.