Skip to main content
SpringerLink
Log in

Use of a Second Generation Antipsychotic among Patients Diagnosed with Major Depressive Disorder in the United States

Prescribing Pattern and Influence of Physician Specialty

  • Short Communication
  • Published:
Pharmaceutical Medicine Aims and scope Submit manuscript

Abstract

Purpose

The purpose of the study was to discern the extent of the prescribing of a second generation atypical antipsychotic (SGA), either alone or in combination with an antidepressant, among patients diagnosed with major depressive disorder (MDD) in the US, and the influence of physician specialty on prescribing in 2007.

Methods

Data from the 2007 US National Ambulatory Medical Care Survey (NAMCS) were extracted for (i) office-based physician-patient encounters (office-based visits; OBV) with an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code for MDD (296.2–296.36, 300.4, 311), and without an ICD-9-CM code(s) for co-morbid mental illness; and (ii) OBV with a diagnosis of MDD marked on the ‘diagnostic clinical checklist’ (DCC) of the NAMCS, and without an ICD-9-CM code(s) for co-morbid mental illness. Rates were calculated per 1000 OBV and per 1000 US population as of 1 July 2007. Statistical analyses were conducted using the Statistical Analysis System (SAS®; Cary, NC, USA) version 9.1.3. The quantitative methods employed addressed the complex survey sampling design of the US NAMCS. Descriptive statistics and logistic regression derived odds ratios (ORs) and 95% confidence intervals (CIs) are reported, as are rates per 1000 OBV and per 1000 US population.

Results

In 2007, there were (i) 28 457 078 OBVs with an ICD-9-CM code for MDD without co-morbid mental illness. Of these, 20 090 702 (70.6%) reported the prescribing of an antidepressant, 2420 885 (8.5%) OBVs reported the prescribing of an SGA (7.4% continued, 1.1% new) and 1 981 968 (7.0%) OBVs reported the prescribing of both an antidepressant and an SGA. The probability of prescribing an SGA increased when the physician specialty was psychiatry (OR 10.97; 95% CI 5.57, 21.58); and (ii) 74561367 OBVs with MDD marked on the DCC without co-morbid mental illness, 37 470 406 (50.3%) OBVs reported the prescribing of an antidepressant, 3 877 385 (5.2%) reported the prescribing of an SGA (4.5% continued, 0.8% new) and 2785941 (3.7%) reported the prescribing of both an antidepressant and an SGA. The probability of prescribing an SGA increased when the physician specialty was psychiatry (OR 10.63; 95% CI 6.68, 16.93). The rate of prescribing of both an antidepressant and an SGA was 2.2 per 1000 when the OBV had an ICD-9-CM code for MDD and 3.1 per 1000 when the OBV had MDD marked on the DCC.

Conclusions

In 2007, for OBVs with either an ICD-9-CM code for MDD or MDD marked on the DCC, there was modest use of an SGA, and the probability of the prescribing of an SGA increased when the specialty of the physician was psychiatry.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Table III
Table IV
Table V

References

  1. WHO. The world heath report: mental health: new understanding, new hope. Geneva: World Health Organization, 2001

    Google Scholar 

  2. Kessler RC, Berglund P, Demler O, et al. National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003; 289 (23): 3095–105

    Article  PubMed  Google Scholar 

  3. Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry 2006; 163: 1905–17

    Article  PubMed  Google Scholar 

  4. Trivedi MH, Fava M, Wisniewski SR, et al., for the STAR*D Study Team. Medication augmentation after the failure of SSRIs for depression. N Engl J Med 2006; 354: 1243–52

    Article  PubMed  CAS  Google Scholar 

  5. American Psychiatric Association. Practice guideline for treatment of patients with major depressive disorder, 3rd ed. Washington, DC, 2010 [online]. Available from URL: http://psychiatryonline.com/pracGuide/pracGuideTopic_7.aspx [Accessed 2011 Oct 1]

  6. WebMD. FDA approves Abilify for depression [online]. Available from URL http://www.webmd.com/depression/news/20071120/fda-oks-abilify-for-depression [Accessed 2011 Oct 1]

  7. MPR. Seroquel XR approved for adjunctive treatment of major depressive disorder (MDD) [online]. Available from URL: http://www.empr.com/seroquel-xr-approved-for-adjunctive-treatment-of-major-depressive-disorder-mdd/article/159147/ [Accessed: 2011 Oct 1]

  8. EmaxHealth. Symbyax approved for treatment-resistant depression [online]. Available from URL: http://www.emaxhealth.com/1024/25/30037/symbyax-approved-treatment-resistant-depression.html [Accessed 2011 Oct 1]

  9. Papakostas GI, Shelton RC, Smith J, et al. Augmentation of antidepressants with atypical antipsychotic medications for treatment-resistant major depressive order: a meta-analysis. J Clin Psychiatry 2007; 68: 826–31

    Article  PubMed  CAS  Google Scholar 

  10. National Center for Health Statistics. Centers for Disease Control and Prevention. NAMCS: National Ambulatory Medical Care Survey, 2007 [online]. Available from URL: http://www.cdc.gov/nchs/ahcd.htm [Accessed 2012 Jun 22]

  11. Bryant E, Shimizu I. Sampling design, sampling variance, and estimation procedures for the National Ambulatory Medical Care Survey. National Center for Health Statistics. Vital Health Stat 1988; 2: 1–39

    Google Scholar 

  12. U.S. Public Health Service and Health Care Financing Administration. International Classification of Diseases, 9th Revision, Clinical Modification, Volume 1. DHHS publication no. (PHS) 89–1260. Washington (DC): Public Health Service, 1989

    Google Scholar 

  13. Koch H, Campbell W. The collection and processing of drug information. National Ambulatory Medical Care Survey, 1980. National Center for Health Statistics, Vital Health Stat 1982; 2: 1–90

    Google Scholar 

  14. Cerner Multum, Inc. Lexicon [online]. Available from URL: http://www.multum.com/Lexicon.htm, [Accessed 2011 Oct 1]

  15. Rush AJ. Limitations in efficacy of antidepressant monotherapy. J Clin Psychiatry 2007; 68 (Suppl. 10): S8–10

    Google Scholar 

  16. Culpepper L. Why do you need to move beyond first-line therapy for major depression? J Clin Psychiatry 2010; 71 (Suppl. 1): S4–9

    Article  Google Scholar 

  17. Dranove D, Meltzer D. Do important drugs reach the market sooner? Rand J Econ 1994; 25: 402–23

    Article  Google Scholar 

  18. Chalkidou K, Tunis S, Lopert R, et al. Comparative effectiveness research and evidence-based health policy: experience from four countries. Milbank Q 2009; 87: 339–67

    Article  PubMed  Google Scholar 

  19. Leslie DL, Rosenheck RA. Benchmarking the quality of schizophrenia pharmacotherapy: a comparison of the Department of Veterans Affairs and the private sector. J Ment Health Policy Econ 2003; 6: 113–21

    PubMed  Google Scholar 

  20. Crystal S, Olfson M, Huang C, et al. Broadened use of atypical antipsychotics: safety, effectiveness, and policy challenges. Health Aff (Millwood) 2009; 28: 770–81

    Article  Google Scholar 

  21. Connolly KR, Thase ME. If at first you don’t succeed: a review of the evidence for antidepressant augmentation, combination and switching. Drugs 2011; 71: 43–64

    Article  PubMed  CAS  Google Scholar 

  22. Jing Y, Kalsekar I, Curkendall SM, et al. Intent-to-treat analysis of health care expenditures of patients treated with atypical antipsychotics as adjunctive therapy in depression. Clin Ther 2011; 33: 1246–57

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by Bristol Myers-Squibb.

Dr Sclar and Ms Robison have served as consultants and received grants from Bristol Myers-Squibb, Dey Pharmaceuticals, Eli Lilly and Company, GlaxoSmithKline, Forest Laboratories and Pfizer. Dr Cohen has served as a consultant to Bristol Myers-Squibb, Dey Pharmaceuticals, Eli Lilly and Company, Merck, Pfizer and Sunovion. Dr Laubmeier and Dr Kalsekar are employees of Bristol Myers-Squibb. Dr Forbes is an employee of Otsuka Pharmaceutical Company.

Author information

Authors and Affiliations

  1. Pharmacoeconomics and Pharmacoepidemiology Research Unit, Department of Health Policy and Administration, College of Pharmacy, Washington State University, P.O. Box 1495, Spokane, Washington, WA 99210-1495, USA

    David A. Sclar B.Pharm, PhD (Boeing Distinguished Professor of Health Policy & Administration, Director), Linda M. Robison & Lawrence J. Cohen

  2. Department of Health Policy and Administration, College of Pharmacy, Washington State University, Spokane, Washington, USA

    David A. Sclar B.Pharm, PhD (Boeing Distinguished Professor of Health Policy & Administration, Director), Linda M. Robison & Lawrence J. Cohen

  3. Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane, Washington, USA

    David A. Sclar B.Pharm, PhD (Boeing Distinguished Professor of Health Policy & Administration, Director) & Lawrence J. Cohen

  4. Department of Statistics, Washington State University, Spokane, Washington, USA

    David A. Sclar B.Pharm, PhD (Boeing Distinguished Professor of Health Policy & Administration, Director)

  5. Washington Institute for Mental Illness Research and Training, Spokane, Washington, USA

    David A. Sclar B.Pharm, PhD (Boeing Distinguished Professor of Health Policy & Administration, Director) & Lawrence J. Cohen

  6. US Medical, Bristol-Myers Squibb, Plainsboro, New Jersey, USA

    Kimberly K. Laubmeier & Iftekhar D. Kalsekar

  7. Global Medical Affairs, Otsuka Pharmaceutical Company, Princeton, New Jersey, USA

    Robert A. Forbes

Authors
  1. David A. Sclar B.Pharm, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Linda M. Robison
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lawrence J. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kimberly K. Laubmeier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Iftekhar D. Kalsekar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert A. Forbes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David A. Sclar B.Pharm, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sclar, D.A., Robison, L.M., Cohen, L.J. et al. Use of a Second Generation Antipsychotic among Patients Diagnosed with Major Depressive Disorder in the United States. Pharm Med 26, 235–241 (2012). https://doi.org/10.1007/BF03262480

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03262480

Keywords

Search

Navigation