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Sachs, Wendy February 8, Similarly, the percentage of visits with 2 or more psychotropic medications increased from The median number of medications prescribed per visit doubled from 1 in to 2 in The mean number increased by The time trend persisted in a multivariate model adjusting for demographic and clinical characteristics of visits Table 1.

The percentage of visits in which 2 or more psychotropic medications were prescribed increased more slowly among visits with an anxiety disorder diagnosis In contrast, visits were less likely to involve 2 or more medications if they were made by men compared with women, self-paying patients compared with those covered by private insurance, and new patients compared with returning patients Table 1. The top section of Table 2 presents numbers and percentages of visits to psychiatrists in which each major medication class and combination were prescribed.

During the study period, antidepressants Combinations of antidepressants with sedative-hypnotics Over time, the percentages of visits in which combinations of antidepressants and antipsychotics or combinations of 2 or more antipsychotics or 2 or more antidepressants were prescribed significantly increased Table 2 , middle and lower sections. In contrast, combinations of mood stabilizers and sedative-hypnotics with each other and with other medication groups did not appreciably change Table 2 , middle and lower sections. The results of multivariate analyses of within—psychotropic medication class combinations were generally consistent with the bivariate analyses Table 3.

The time trend for 2 or more sedative-hypnotics, which was not statistically significant in bivariate analyses, became significant in the multivariate model Table 3. Specific psychotropic medication combinations were significantly more commonly prescribed for some patient groups than others Table 3. Combinations of 2 or more antidepressants, for example, were significantly more common in visits by patients aged 45 to 64 years compared with visits by patients aged 18 to 44 years, women compared with men, and patients with mood and anxiety disorders compared with other diagnoses Table 3.

A combination of 2 or more antipsychotics was significantly more common in visits with a diagnosis of schizophrenia compared with other diagnoses and in visits paid for with public compared with private insurance Table 3. This medication combination was less common in visits with a diagnosis of other depressive disorders. Over time, the prevalence of visits with 2 or more antipsychotics modestly decreased in the treatment of major depression 1. The prevalence of visits with 2 or more mood stabilizers did not change across survey years. However, such visits were many times more common in the treatment of bipolar disorder compared with other diagnoses 5.

Metabolic Effects of Psychotropic Drugs (Modern Trends in Pharmacopsychiatry Vol 26)

Two or more sedative-hypnotics were more commonly prescribed in visits by women than by men, visits with a diagnosis of anxiety disorder than other diagnoses, visits with more than 1 psychiatric diagnosis than those with 1 diagnosis, and visits covered by Medicare than other payers. Furthermore, interaction terms of survey year with the 65 years and older age group, diagnosis of schizophrenia, and Medicare insurance coverage were statistically significant, indicating that time trends were significantly different across these groups. Over time, multiple sedative-hypnotics became more commonly prescribed in visits by patients younger than 65 years 3.

This medication combination also became more common in visits by patients with diagnoses other than schizophrenia 3. The combination of 2 or more sedative-hypnotics also became less commonly prescribed in Medicare-insured visits 7. The association of survey year with prescription of antidepressant-antipsychotic combinations persisted in multivariate analysis Table 4. Antidepressant-antipsychotic combinations were also more commonly prescribed in visits by women than men; visits with diagnoses of major depression, bipolar disorder, and schizophrenia than other diagnoses; visits with more than 1 psychiatric diagnosis; and visits covered by public insurance or payment arrangements other than private insurance or self-pay, but less commonly in visits by the 65 years and older age group than younger patients Table 4.

Antidepressant—mood stabilizer combinations were more common in visits with a bipolar or schizophrenia diagnosis than those with other diagnoses and by new compared with returning patients Table 4. Antidepressant and sedative-hypnotic combinations occurred disproportionately in visits by patients aged 45 to 64 years, visits with a diagnosis of major depression or anxiety disorder, and visits covered by Medicare. This combination was less commonly prescribed in visits by men, minorities, and self-paying patients Table 4.

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Antipsychotic—mood stabilizer combinations were significantly more common in visits with a bipolar disorder or schizophrenia diagnosis compared with other diagnoses. By contrast, this combination was less commonly prescribed among visits by older patients compared with younger patients and among those with depressive disorders, anxiety disorders, and new patients as compared with returning patients Table 5. Antipsychotic and sedative-hypnotic combinations were significantly more common in visits by patients aged 45 to 64 years than the younger age group, visits with a diagnosis of bipolar disorder or schizophrenia, visits with more than 1 diagnosis, and visits with public insurance than other payment sources.

This combination was less commonly prescribed for visits by older adults than younger adults, men than women, and new than returning patients Table 5. Finally, mood stabilizer—sedative-hypnotic combinations were more commonly prescribed in visits by patients aged 45 to 64 years compared with younger adults and visits with a bipolar or schizophrenia diagnosis compared with other diagnoses Table 5. The results of this study should be interpreted in the context of several limitations.

First, this is an observational study and although the multivariate analyses adjust for a number of patient and visit characteristics, the range of variables is limited and multivariate methods cannot rule out residual confounding due to unmeasured differences among patient groups across survey years. Thus, results should be interpreted with caution. Second, the analyses were limited to office-based psychiatric practices. The trends and patterns in psychotropic polypharmacy may not generalize to other treatment settings. Thus, psychotropic polypharmacy is not limited to psychiatric practices.

Third, because of the cross-sectional survey design, it is not possible to determine previous clinical response to monotherapy regimens or the course of medication treatment or to measure the effects of trends in psychotropic polypharmacy on clinical outcomes.

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For patients who receive care from several physicians, the survey may underestimate the number of psychotropic medications actually taken by individual patients. Furthermore, results for the less common medication combinations, such as combinations of 2 or more mood stabilizers, should be interpreted with caution. Sixth, diagnoses might not be exactly comparable across time. For example, patients given a diagnosis of bipolar disorder in might be somewhat different from those given this diagnosis in Without expert validation or structured interviews, it is not possible to examine these variations.

Finally, because NAMCS records visits rather than patients, some patient duplication may have occurred during the 1-week sampling period. Despite these limitations, this report represents the first national study of psychotropic polypharmacy trends in office-based psychiatric practice to our knowledge. Between and , there was a substantial increase in the proportion of patient visits in which 2 or more psychotropic medications were prescribed.