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National Trends in Second-Generation Antipsychotic Augmentation for Nonpsychotic Depression
Objective: This study estimates national trends and patterns in use of second-generation antipsychotics (SGAs) for adjunctive treatment of nonpsychotic adult depression in office-based practice.
Method: Twelve consecutive years (1999–2010) of the National Ambulatory Medical Care Survey were analyzed to estimate trends and patterns of adjunctive SGA treatment for adult (≥ 18 years) nonpsychotic depression in office-based visits. Adjunctive SGA use was examined among all office visits in which depression was diagnosed (N = 7,767), excluding visits with diagnoses for alternative SGA indications (schizophrenia, bipolar disorder, pervasive development disorder, psychotic depression, dementia) and those without an active antidepressant prescription.
Results: From 1999 to 2010, 8.6% of adult depression visits included an SGA. SGA use rates increased from 4.6% in 1999–2000 to 12.5% in 2009–2010, with an adjusted odds ratio (AOR) for time trend of 2.78 (95% CI, 1.84–4.20). The increase in SGA augmentation was broad-based, with no significant differences in time trends between demographic and clinical subgroups. For the most recent survey years (2005–2010), SGA use rates were higher in visits to psychiatrists than to other physicians (AOR = 5.08; 95% CI, 2.96–8.73), visits covered by public than private insurance (AOR = 3.20; 95% CI, 2.25–4.54), visits with diagnosed major depressive disorder than other depressive disorders (AOR = 1.49; 95% CI, 1.08–2.06), and visits with diabetes, hyperlipidemia, or cardiovascular disease (AOR = 2.13; 95% CI, 1.12–4.03) and lower in visits by patients > 65 years than 18–44 years (AOR = 0.51; 95% CI, 0.32–0.82) and visits that included psychotherapy (AOR = 0.68; 95% CI, 0.47–0.96).
Conclusions: Between 1999 and 2010, SGAs were increasingly accepted in the outpatient treatment of adult nonpsychotic depression.
J Clin Psychiatry
© Copyright 2014 Physicians Postgraduate Press, Inc.
Submitted: July 8, 2013; accepted October 2, 2013.
Online ahead of print: January 7, 2014 (doi:10.4088/JCP.13m08675).
Corresponding author: Tobias Gerhard, PhD, Ernest Mario School of Pharmacy and Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, 112 Paterson St, New Brunswick, NJ 08901 (firstname.lastname@example.org).