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Mental Health Drug Use Increasing Rapidly
Jan. 13, 2005 -- More Americans than ever are being treated for substance abuse, depression, and other mental health disorders, but the treatment they are getting is increasingly limited to prescription drugs alone.
That is the finding from a government study that assessed changing patterns in the treatment of mental illnesses from the mid-1990s to 2001. While the number of people receiving other types of treatment, such as psychotherapy or behavioral therapy, remained the same during the five-year evaluation period, prescription drug use increased rapidly.
Mental Health Drug Costs Rose 20% a Year
Among the study highlights:
- Approximately 30.5 million people in the U.S. were treated for psychiatric disorders in 2001, 5.5 million more than were being treated in 1996.
- 34% of those treated for mental health problems and substance abuse in 2001 received drug treatment alone, up from 26% in 1996.
- The average annual cost of taking antidepressants and other mental health drugs rose from $374 per user to $639 between 1996 and 2001. That represents an increase of almost 20% a year, far higher than the average increase of 13% for prescription drugs overall.
Economist Samuel H. Zuvekas, PhD, who conducted the analysis, says about 80% of the growth in mental health expenditures can be explained by the increase in the use of selective serotonin reuptake inhibitors (SSRIs) and other antidepressants, and high-priced schizophrenia drugs called "atypical antipsychotics," like Risperdal, Zyprexa, and Geodon.
The atypical antipsychotics, which are also being used to treat bipolar and anxiety disorders, cost patients roughly $8 a day, about 100 times more than the most widely prescribed older antipsychotic drug, Haldol.
Substance abuse and mental health disorders have historically been undertreated, with some studies showing that less than a third of the people with severe mental disorders are treated. According to Zuvekas, the latest findings indicate that the gap between mental health need and treatment is closing.
"There are clearly a lot more people getting treatment, which is a trend that we began to see with the introduction of Prozac in the late 1980s," he says.
Prozac is credited with bringing drug treatment for mental health disorders to the masses. It was the first of the SSRIs, but is now prescribed less often than newer, and more expensive, SSRI and non-SSRI antidepressants.
Are Enough People Being Treated?
UCLA professor of psychiatry Kenneth B. Wells, MD, MPH, has been tracking the utilization of mental health care as part of a national study. While he agrees that more people than ever may be getting treated, he tells WebMD that the unmet need for treatment is still great.
"Probably no more than half of the people with mental disorders get any kind of care," he says. "And about half of those who do get care obtain it through their primary care doctor, which means they are probably getting drugs alone."
Wells says studies show that drug treatment is as effective as other treatments for depression and many other types of mental illnesses. But he adds that for some disorders, such as schizophrenia, combining drugs with psychotherapy is usually more effective than drug therapy alone.
"I don't know if the trend toward drug treatment is affecting the quality of care," he says. "But I think the more important question is, 'Are enough people in need being treated at all?' and it is clear that the answer is no."
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