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Treatment with Antidepressant Medications in Private Health Plans

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Abstract

This study analyzed 2002 MarketScan data from a convenience sample of enrollees with private health insurance from the largest U.S. firms to examine utilization, expenditures, and factors associated with antidepressant prescriptions. Of enrollees, 11% received at least one antidepressant prescription during the year with average expenditures per enrollee of $51.55. Antidepressant prescriptions were more frequently used than any form of other mental health care and for 42% of users was not associated with any clearly identified mental health or “off-label” indication. In logistical regression analyses, health plan type, prescription days supply, gender, region, age, employment status, and subscriber status were associated with unexplained antidepressant prescription use.

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Notes

  1. For Zoloft and Prozac ‘Premenstrual Dysphoric Disorder’ is a labeled condition.

References

  • Adams, C., & Young, A. (2003, November 2–4). Off-label prescribing, an investigative series by Knight-Ridder. Knight-Ridder Newspapers.

  • Asarnow, J. R., Jaycox, L. H., Duan, N., LaBorde, A. P., Rea, M. M., Murray, P., et al. (2005). Effectiveness of a quality improvement intervention for adolescent depression in primary care clinics: A randomized controlled trial. Journal of the American Medical Association, 293(3), 311–319.

    Article  PubMed  CAS  Google Scholar 

  • Barents Group LLC (1999). Factors affecting the growth of prescription drug expenditures. Washington, DC: The National Institute for Health Care Management Research and Educational Foundation.

    Google Scholar 

  • Coffey, R. M., Mark, T., King, E., Harwood, H., McKusick, D., Genuardi, J., et al. (2000, July). National estimates of expenditures for mental health and substance abuse treatment, 1997 (No. SAMHSA Publication No. SMA-00–3499). Rockville, MD: Center for Substance Abuse Treatment and Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.

  • Cooper, W. O., Arbogast, P. G., Ding, H., Hickson, G. B., Fuchs, D. C., & Ray, W. A. (2006). Trends in prescribing of antipsychotic medications for US children. Ambulatory Pediatrics, 6(2), 79–83.

    Article  PubMed  Google Scholar 

  • Coyle, J. T. (2000). Psychotropic drug use in very young children. Journal of the American Medical Association, 283(8), 1059–1060.

    Article  PubMed  CAS  Google Scholar 

  • Croghan, T. W., & Pittman, P. M. (2004). The medicine cabinet: What’s in it, why, and can we change the contents? Health Affairs (Millwood), 23(1), 23–33.

    Article  Google Scholar 

  • Croghan, T. W. (2001) The controversy of increased spending for antidepressants. Health Affairs (Millwood), 20, 129–135.

    Article  CAS  Google Scholar 

  • FDA (2004). Antidepressant use in children, adolescents, and adults. Retrieved October 12, 2004, from http://www.fda.gov/cder/drug/antidepressants/default.htm

  • FDA (2005). Summaries of medical and clinical pharmacology reviews—pediatric studies. Retrieved June 10, 2005, from http://www.fda.gov/cder/pediatric/Summaryreview.htm

  • Guck, T. P., Kavan, M. G., Elsasser, G. N., & Barone, E. J. (2001). Assessment and treatment of depression following myocardial infarction. American Family Physician, 64(4), 641–648.

    PubMed  CAS  Google Scholar 

  • Katon, W., Von Korff, M., Lin, E., Simon, G., Walker, E., Bush, T., et al. (1997). Collaborative management to achieve depression treatment guidelines. Journal of Clinical Psychiatry, 58(Suppl 1), 20–23.

    PubMed  Google Scholar 

  • Katon, W. J., Roy-Byrne, P., Russo, J., & Cowley, D. (2002). Cost-effectiveness and cost offset of a collaborative care intervention for primary care patients with panic disorder. Archives of General Psychiatry, 59(12), 1098–1104.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., et al. (2003). The epidemiology of major depressive disorder: Results from the national comorbidity survey replication (NCS-R). Journal of the American Medical Association, 289(23), 3095–3105.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 617–627.

    Article  PubMed  Google Scholar 

  • Larson, M. J., Miller, K., & Fleming, K. J. (2004). Mental health services and psychotropic drug use in employer-sponsored health plans, 2002. Final report submitted to Center on Mental Health Services (Judith Teich, project officer), December, 2004.

  • Larson, M. J., Miller, K. & Fleming, K. J. (2006). Datapoints: Antidepressant medication use in private insurance health plans, 2002. Psychiatric Services, 57, 175.

    Article  PubMed  Google Scholar 

  • Le Melledo, J. M., Bailey, D., & Baker, G. B. (2004). Selective serotonin reuptake inhibitors and myocardial infarction. Circulation, 109(3), E19.

    Article  CAS  Google Scholar 

  • Loder, E. W., & Biondi, D. M. (2004). Off-label prescribing of drugs in specialty headache practice. Headache, 44(7), 636–641.

    Article  PubMed  Google Scholar 

  • Manisses Communications Group (2003). The psychopharmacology desktop reference (3rd ed.). Providence, RI: Manisses Communications Group, Inc.

  • Mark, T. L., Coffey, R. M., Vandivort-Warren, R., Harwood, H. J., King, E. C., & MHSA Spending Estimates Team, A. T. (2005, March 29). U. S. Spending for mental health and substance abuse treatment, 1991–2001. Health Affairs (Millwood). Retrieved April 5, 2005, from http://www.content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.133.

  • McCorry, F., Garnick, D. W., Bartlett, J., Cotter, F., & Chalk, M. (2000). Developing performance measures for alcohol and other drug services in managed care plans. The Joint Commission Journal of Quality Improvement, 26(11), 633–643.

    CAS  Google Scholar 

  • National Institute of Mental Health (2003). Childhood-onset schizophrenia: An update from the National Institute of Mental Health. Bethesda (MD): NIMH, National Institutes of Health, US Department of Health and Human Services. (NIH Publication Number: NIH 5124). Accessed, April 1, 2006, http://www.nimh.nih.gov/publicat/schizkids.cfm

  • National Committee for Quality Assurance (2005). The State of Health Care Quality 2005. NCQA: Washington DC. Accessed April 1, 2006. http://www.ncqa.org/Docs/SOHCQ_2005.pdf

  • Olfson, M., Gameroff, M. J., Marcus, S. C., & Waslick, B. D. (2003). Outpatient treatment of child and adolescent depression in the united states. Archives of General Psychiatry, 60(12), 1236–1242.

    Article  PubMed  Google Scholar 

  • Olfson, M., Marcus, S. C., Druss, B., Elinson, L., Tanielian, T., & Pincus, H. A. (2002). National trends in the outpatient treatment of depression. Journal of the American Medical Association, 287(2), 203–209.

    Article  PubMed  Google Scholar 

  • Olfson, M., Marcus, S. C., Pincus, H. A., Zito, J. M., Thompson, J. W., & Zarin, D. A. (1998). Antidepressant prescribing practices of outpatient psychiatrists. Archives of General Psychiatry, 55(4), 310–316.

    Article  PubMed  CAS  Google Scholar 

  • Ornstein, S., Stuart, G., & Jenkins, R. (2000). Depression diagnoses and antidepressant use in primary care practices: A study from the Practice Partner Research Network (PPRNet). Journal of Family Practice, 49(1), 68–72.

    PubMed  CAS  Google Scholar 

  • PDR (2002). Physician’s desk reference—Drug guide for mental health professionals-first edition (1st ed.). Montvale, NJ: Thomson Medical Economics.

    Google Scholar 

  • Pomerantz, J. M. (2003). Antidepressants used as placebos: Is that good practice? Drug Benefit Trends, 15(8), 32–33.

    Google Scholar 

  • Pomerantz, J. M., Finkelstein, S. N., Berndt, E. R., Poret, A. W., Walker, L. E., Alber, R. C., et al. (2004). Prescriber intent, off-label usage, and early discontinuation of antidepressants: A retrospective physician survey and data analysis. Journal of Clinical Psychiatry, 65(3), 395–404.

    Article  PubMed  Google Scholar 

  • Renaud, J., Axelson, D., & Birmaher, B. (1999). A risk-benefit assessment of pharmacotherapies for clinical depression in children and adolescents. Drug Safety, 20(1), 59–75.

    Article  PubMed  CAS  Google Scholar 

  • Robinson, R. L., Long, S. R., Cheng, S., Able, S., Baser, O., Obenchain, R. L., et al. (2006). Higher costs and therapeutic factors associated with adherence to NCQA HEDIS antidepressant medication management measures: Analysis of administrative claims. Journal of Managed Care Pharmacy, 12(1), 43–54.

    PubMed  Google Scholar 

  • Ross, E. C. (1997). Managed behavioral health care premises, accountable systems of care, and AMBHA’s PERMS. Evaluation Review, 21(3), 318–321.

    Article  PubMed  CAS  Google Scholar 

  • Rost, K., Smith, R., Matthews, D. B., & Guise, B. (1994). The deliberate misdiagnosis of major depression in primary care. Archives of Family Medicine, 3(4), 333–337.

    Article  PubMed  CAS  Google Scholar 

  • Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Stewart, J. W., Nierenberg, A. A., Thase, M. E., et al. (2006). Bupropion-SR, Sertaline, or Venlafaxine-XR after failure of SSRIs for depression. The New England Journal of Medicine, 354, 1231–1242.

    Article  PubMed  CAS  Google Scholar 

  • Sauer, W. H., Berlin, J. A., & Kimmel, S. E. (2001). Selective serotonin reuptake inhibitors and myocardial infarction. Circulation, 104(16), 1894–1898.

    Article  PubMed  CAS  Google Scholar 

  • Schulberg, H. C., Katon, W., Simon, G. E., & Rush, A. J. (1998). Treating major depression in primary care practice: An update of the agency for health care policy and research practice guidelines. Archives of General Psychiatry, 55(12), 1121–1127.

    Article  PubMed  CAS  Google Scholar 

  • Scott, J., Palmer, S., Paykel, E., Teasdale, J., & Hayhurst, H. (2003). Use of cognitive therapy for relapse prevention in chronic depression. Cost-effectiveness study. British Journal of Psychiatry, 182, 221–227.

    Article  PubMed  Google Scholar 

  • Sekula, L. K., DeSantis, J., & Gianetti, V. (2003). Considerations in the management of the patient with comorbid depression and anxiety. Journal of the American Academy of Nurse Practitioners, 15(1), 23–33.

    Article  PubMed  Google Scholar 

  • Simon, G. E., Savarino, J., Operskalski, B., & Wang, P. S. (2006). Suicide risk during antidepressant treatment. American Journal of Psychiatry, 163(1), 41–47.

    Article  PubMed  Google Scholar 

  • Stafford, R. S., Ausiello, J. C., Misra, B., & Saglam, D. (2000). National patterns of depression treatment in primary care. Primary Care Companion to the Journal of Clinical Psychiatry, 2(6), 211–216.

    PubMed  Google Scholar 

  • Stone, K. J., Viera, A. J., & Parman, C. L. (2003). Off-label applications for SSRIs. American Family Physician, 68(3), 498–504.

    PubMed  Google Scholar 

  • Tabarrok, A. T. (2000). Assessing the FDA via the anomaly of off-label drug prescribing. The Independent Review, 5(1), 25–53.

    Google Scholar 

  • Tata, L. J., West, J., Smith, C., Farrington, P., Card, T., Smeeth, L., et al. (2005). General population based study of the impact of tricyclic and selective serotonin reuptake inhibitor antidepressants on the risk of acute myocardial infarction. Heart, 91(4), 465–471.

    Article  PubMed  CAS  Google Scholar 

  • Trivedi, M. H., Fava, M., Wisniewski, S. R., Thase, M. E., Quitkin, F., Warden, D., et al. (2006). Medication augmentation after the failure of SSRIs for depression. The New England Journal of Medicine, 354, 1243–1252.

    Article  PubMed  CAS  Google Scholar 

  • U. S. Department of Health and Human Services (1999). Mental health: A report of the surgeon general. Rockville, MD: U. S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.

  • Vitiello, B., & Swedo, S. (2004). Antidepressant medications in children. New England Journal of Medicine, 350(15), 1489–1491.

    Article  PubMed  CAS  Google Scholar 

  • Zuvekas, S. H. (2005). Prescription drugs and the changing patterns of treatment for mental disorders, 1996–2001. Health Affairs (Millwood), 24(1), 195–205.

    Article  Google Scholar 

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Authors and Affiliations

  1. Institute for Health Services Research, New England Research Institutes Inc., 9 Galen St., Watertown, MA, 02472, USA

    Mary Jo Larson

  2. Medstat, 5425 Hollister Avenue, Suite 140, Santa Barbara, CA, 93111-2348, USA

    Kay Miller

  3. New England Research Institutes, Inc., Watertown, MA, USA

    Kathleen J. Fleming

Authors
  1. Mary Jo Larson
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  2. Kay Miller
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  3. Kathleen J. Fleming
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Correspondence to Mary Jo Larson.

Appendix

Appendix

  Identified uses of 6 top-selling antidepressant medications
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Larson, M.J., Miller, K. & Fleming, K.J. Treatment with Antidepressant Medications in Private Health Plans. Adm Policy Ment Health 34, 116–126 (2007). https://doi.org/10.1007/s10488-006-0088-5

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