Preparing to write this post, I started to survey the media coverage of the latest report from pharmacy giant Medco on how many Americans are taking psychiatric medications. The straight news coverage was okay, but many others simply used the report as a chance to declare – again -that Americans are “overmedicated.”
I don’t see how you can you honestly declare that a whole country, or even any particular group, is “overmedicated” unless you can also determine what number would constitute “appropriately medicated.” Not surprisingly, few people sounding off on either this report or the larger issue are willing to make such a call.
In the interest of moving the discussion into more substantive territory, I’d like to highlight a few findings from the report, which included data from 2001 to 2010:
Children and Teenagers
The Medco data showed only a slight uptick over the past decade in the percentage of kids under age 20 taking medications – about 5 percent in 2001 and about 6 percent in 2011. Considering the rhetoric we tend to hear about kids and meds, this is a pretty small increase.
Similar to academic studies I’ve seen, Medco found that antidepressant use in kids has declined since 2004, when the FDA warned about the drugs increasing the risk of suicidal thoughts and behaviors in young people.
The one potentially eyebrow-raising finding, in my opinion, was the fact that the greatest increase in prescriptions for benzodiazepines occurred in kids ages 10 to 19.
Many people – myself included – have found benzos to be enormously effective for acute bouts of anxiety. Still, it’s easy to develop a tolerance to them, and coming off them can be hell. And because benzos are often taken on an as-needed basis, there’s the potential for kids to become psychologically dependent on them – to worry that their anxiety will spike if they don’t take them.
When examining the increase, though, it’s important to remember that historically doctors have been reluctant to prescribe benzos to young people. They worried about many of the issues I just mentioned, and about the drugs’ potential to be abused. So, it’s very possible they were over-cautious in the past and that the bump in prescriptions just reflects a more reasonable level of caution.
Regardless, I think the same rule of thumb holds true for benzos as for other psych meds: Doctors and parents should monitor children extra carefully and keep older kids appraised of the risks.
The report also has stats about adults ages 2o to 44, but doesn’t subdivide that group any further. (Being particularly interested in young people who grew up when the prescribing of psychopharmaceuticals started to take off in the 1990s, I wish it did). Still, some notable points jump out.
The use of atypical antipsychotics – drugs given for schizophrenia, bipolar disorder and an expanding array of behavioral problems – is actually increasing more quickly in this 20-44 age group than in kids, which is interesting because most of the press has been devoted to children. Use of the atypicals nearly doubled in kids – but it almost tripled in the 20-44 age group.
Prescriptions also nearly tripled for ADHD drugs like Ritalin, Adderall and Concerta in this age group, whereas the increase in children was far more modest.
The dramatic increase in these two classes of drugs could be due to several factors. Those include: 1) In the past decade, the young people who were medicated as children or teens have entered young adulthood and are still taking drugs 2) Previously unmedicated young adults are going on medications in increasing numbers or 3) People who took meds as children or teens are adding or switching to the atypicals and ADHD meds.
It would be fascinating to know the extent to which each of these scenarios is playing out, and which other factors are at play. Unfortunately, like most statistics, this report is a snapshot. It’s not tracking the same people over time, so we don’t know what’s driving the increases.
We also don’t know what conditions the drugs were prescribed for (there are plenty of good arguments against psychiatry’s diagnostic system, but at least knowing diagnoses would provide a richer picture of what’s happening).
Feel free to weigh in with your thoughts on what’s contributing to these trends!