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To the Editor: Dr Tseng and colleagues¹ found that Medicare patients with lower annual benefits were more likely to exceed these "caps," and that such patients were likely to face increased out-of-pocket costs to continue receiving their medication. The authors also found that 15 of the 20 medications with the highest total prescription expenditures were for chronic conditions. Although it seems reasonable to assume that most of these medications are indeed prescribed for chronic conditions, the antidepressant paroxetine (fifth on the list of Tseng et al) is also indicated for some anxiety disorders, which could be considered chronic conditions.

Both anxiety and depression are highly prevalent in elderly patients and probably are underdiagnosed and undertreated. Appropriate treatment is frequently a long-term proposition. It has been my sad experience to discuss with older patients, usually after the fact, that they had opted to forgo their psychiatric medication in favor of treatment . . . [Full Text of this Article]

Richard Moldawsky, MD
Southern California Permanente Medical Group
Anaheim

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