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Primary Care, Psychiatry, and Other Medical Specialties

Harold Alan Pincus, MD; Terri L. Tanielian, MA; Steven C. Marcus, MA; Mark Olfson, MD, MPH; Deborah A. Zarin, MD; James Thompson, MD, MPH; Julie Magno Zito, PhD

JAMA. 1998;279:526-531.

Context.— Psychotropic medications are widely prescribed, but how new classes of psychotropic medications have affected prescribing patterns has not been well documented.

Objective.— To examine changes between 1985 and 1994 (data from 1993 and 1994 were combined) in the prescribing patterns of psychotropic medications by office-based primary care physicians, psychiatrists, and other medical specialists.

Design.— National estimates for the number of visits during which a physician prescribed a psychotropic medication based on the National Ambulatory Medical Care Surveys conducted in 1985, 1993, and 1994.

Setting.— Office-based physician practices in the United States.

Participants.— A systematically sampled group of office-based physicians.

Main Outcome Measures.— National estimates of visits that included a psychotropic medication.

Results.— The number of visits during which a psychotropic medication was prescribed increased from 32.73 million to 45.64 million; the proportion of such visits, as a proportion of all visits, increased from 5.1% to 6.5% (P.01). Antianxiety or hypnotic drug visits, previously the largest category, decreased as a proportion of psychotropic drug visits (P.01) and are now surpassed by antidepressant visits. Visits for depression increased from 10.99 million in 1988 to 20.43 million in 1993 and 1994 (P.01). Stimulant drug visits increased from 0.57 million to 2.86 million (P.01). Although visits for depression doubled for both primary care physicians and psychiatrists, the proportion of visits for depression during which an antidepressant was prescribed increased for psychiatrists but not for primary care physicians.

Conclusions.— The patterns of psychotropic medication use in outpatient medical practice changed dramatically during the study period, especially in psychiatric practice.

From the Office of Research, American Psychiatric Association, Washington, DC (Drs Pincus and Zarin and Ms Tanielian); Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pa (Mr Marcus); New York State Psychiatric Institute and the Department of Psychiatry, Columbia University, New York (Dr Olfson); Department of Psychiatry, University of Maryland at Baltimore (Dr Thompson); and the Department of Pharmacy, Practice and Science, University of Maryland at Baltimore (Dr Magno Zito). Dr Thompson is now with the Office of Education, American Psychiatric Association.

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