Prescription psychotropic medication use among the U.S. adult population: results from the third National Health and Nutrition Examination Survey, 1988-1994

OBJECTIVE

We estimated prescription psychotropic medication use among US adults.

METHODS

We examined household interview data from the third National Health and Nutrition Examination Survey (1988-1994) for persons 17 years and older (n=20,050).

STUDY DESIGN AND SETTING

An estimated 10 million adults (5.5%) reported psychotropic medication use during a 1-month period. The use of anxiolytics, sedatives, and hypnotics (ASH) was most common (3.2%), followed by antidepressants (2.3%), antipsychotics (0.7%), and antimanics (0.1%). Psychotropic medication use was more prevalent among women than men (P<.001), non-Hispanic whites than non-Hispanic blacks (P<.001) and Mexican Americans (P<.001), and older rather than younger age groups (P<.001). Psychotropic medication use was also most common among those below the federal poverty level, those with no high school education, and among insured persons. Only 1% of adults used two or more psychotropic medications monthly.

CONCLUSION

Many adults use psychotropic medications on a monthly basis. ASH users comprised the largest proportion of psychotropic medication users. Patterns of use varied by several socio-demographic factors.

Generalised anxiety disorder: treatment options

In recent years generalised anxiety disorder (GAD) has become a much better defined disorder, with specific criteria distinguishing it from the other anxiety disorders; however, it still lacks the same public and scientific interests as some of the other anxiety disorders such as panic and social phobia. Nevertheless, refinement in the treatment of GAD is becoming more evident through the conduct of clinical trials. Up until the mid-1980's, treatment consisted primarily of benzodiazepines. However, as a result of growing characterisation of their abuse potential, other therapeutic options were explored. Benzodiazepines became seen as an effective short-term therapy, and buspirone and some of the newer antidepressants have become the treatment of choice for patients with GAD requiring long-term treatment. Buspirone was the first available alternative to the benzodiazepines in the US; however, the initial excitement over this agent was somewhat dampened because of its mild efficacy combined with a slow onset of action. The antidepressants were seen as beneficial for the treatment of GAD because of the high comorbidity with depression, thus allowing a better outcome for these patients. The antidepressants that offer both a good adverse effect profile and efficacy are the selective serotonin reuptake inhibitors including paroxetine, and the serotonin-norepinephrine reuptake inhibitors such as venlafaxine. Clinicians should also consider the potential benefits of psychotherapy as an adjunct to medication. There are a number of potentially new pharmacotherapies being investigated, including newer serotonin 5-HT1A receptor agonists, cholecystokinin receptor antagonists, neurokinin receptor antagonists, gabapentin and its analogues, and gamma-aminobutyric acid (GABA)A receptor modulators. However, these compounds are all in the early stages of investigation, and there are no new therapies expected to be released in the near future. Nonetheless, in the search for the ideal anxiolytic, a more positive outlook is allowed by imminent future research for new treatment options in patients with GAD.

Effects of social defeat and of diazepam on behavior in a resident-intruder test in male DBA/2 mice

Social stress induces robust behavioral and physiological changes, some of which may alter the responsiveness to pharmacological agents, including diazepam (DZP). We used a resident-intruder paradigm to (1) develop a comprehensive ethogram of behavioral changes following social defeat (SD) in the socially reactive strain, DBA/2 male mice, (2) determine whether acute exposure of DBA/2 mice to low-dose DZP would induce flight or aggressive behavior, both of which have been observed in other rodent models and (3) to test whether prior social stress affects responses to DZP. Behavioral responses to a nonaggressive intruder (NAI) mouse 24 h post-SD were measured in resident subject mice exposed to DZP (0, 0.5, 2.0 mg/kg, ip) either prior to the resident-intruder test (Experiment 1) or immediately post-SD (Experiment 2); control mice were not defeated (NOSD). In general, SD mice displayed increased passive and active avoidance, defense, immobility, and risk assessment relative to NOSD mice. In Experiment 1, mice treated acutely with 0.5 mg/kg DZP had more approach and flight behavior, while those treated with 2.0 mg/kg DZP had more avoidance than vehicle-treated mice, independent of SD. In Experiment 2, acute DZP (2 mg/kg) induced effects 24 h later, possibly secondary to withdrawal. In a nonsocial context (Experiment 3), DZP increased exploratory activity.

The Undertreatment of Anxiety: Overcoming the Confusion and Stigma

1. The patient, the nurse, and organizational variables all interact in a dynamic and complex manner, which all have an impact on decisions about intervention. 2. The numbers and variety of agents ordered as PRN indicate the responsibility for treatment placed by physicians on nurses and their reliance on appropriate and accurate nursing assessment. 3. Much of the stigma surrounding symptoms of anxiety and their treatment is based not only on the nature of the illness, but on the perceptions and beliefs concerning the use of anti-anxiety agents.

Anxiety, depression, and substance use disorders: diagnosis, treatment, and prescribing practices

Attending physicians routinely encounter patients with signs and symptoms of anxiety and mood disorders as well as psychoactive substance use and psychoactive substance-induced organic mental disorders. These symptoms may represent either primary disorders or pathology that is secondary to other disorders. This article describes some of the relationships between substance use disorders and symptoms of anxiety and depressive disorders. In addition, some patients with these disorders may have a concurrent substance use disorder or be at high risk for developing one. Routine treatment of anxiety disorders with psychoactive drugs can be successful in many patients but may lead to iatrogenic dependence in high-risk patients. Prescribing for high-risk patients should include a stepwise treatment protocol having three progressive levels: (1) conservative, nonpharmacological approaches; (2) nonpsychoactive pharmacotherapy, including the use of anxioselective agents, such as buspirone; and (3) psychoactive pharmacotherapy, such as the use of benzodiazepines. Proper prescribing practices for high-risk patients are described in terms of diagnosis, dosage, duration, discontinuation, dependence, and documentation.

Diazepam (Valium): its dependency liability

Reports of the withdrawal syndrome following discontinuation of diazepam and drug dependence fears have contributed to diazepam's displacement as the most popular anxiolytic agent. Reports of the withdrawal syndrome, the factors involved in withdrawal, and the remedies proposed for diazepam withdrawal symptoms are reviewed.

Considerations in using psychotropic medication with dual diagnosis patients in recovery

This article addresses some of the issues that arise when chemically dependent patients with coexisting psychiatric disorders require medication. A history of chemical dependence may alter prescribing practices, as certain medications may have a higher abuse potential or may enhance the danger of relapse to the primary drug of abuse. Recovering patients have complex attitudes and feelings toward medications that need to be explored, particularly as they affect compliance with prescribed regimens. Issues arising in the treatment of anxiety disorders, depression, and attention deficit disorders are discussed. Guidelines are provided for therapists working with prescribing physicians, and for handling problems that may arise in conjunction with 12-Step program participation.

Benzodiazepine withdrawal: overview and implications for the treatment of anxiety

The authors critically review 20 reports (studies and large case series) detailing the nature, severity, and variability of benzodiazepine withdrawal syndromes. Factors affecting the frequency and intensity of withdrawal are identified, and methodologic problems limiting the generalizability of certain findings are pointed out. Treatment approaches for minimizing withdrawal are reviewed, and implications for the problem of long-term benzodiazepine use and dependence are discussed.