SAMHSA study shows how psychiatric drugs prescribed for medical conditions

A new study sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) outlines the conditions that physicians around the country reported treating with psychiatric drugs such as antipsychotics, antidepressants, and anti-anxiety drugs.

Psychiatric medications are one of the most widely prescribed categories of drugs in the nation; yet few studies have comprehensively examined the types of illnesses being treated with these medications. In particular, there has been a great deal of interest and some concern about how psychiatric drugs are being prescribed for medical conditions not included in their Food and Drug Administration-approved labeling - or "off-label" -- use. In most instances it is legal and a common practice for physicians to prescribe drugs off-label, even though less may be known about a drug's risks and benefits for an unapproved indication.

Although this study did not evaluate whether drugs were prescribed for on- or off-label use, the study reveals that in the vast majority of cases physicians are prescribing psychiatric medications for patients with psychiatric conditions. These medications are also sometimes prescribed to treat other conditions. This is particularly true in the case of anti-anxiety drugs.

"From this study it seems clear that psychiatric medications are for the most part being prescribed for treating people with psychiatric conditions," said SAMHSA Administrator Pamela S. Hyde, J.D. "Yet, as clinicians broaden their use of psychiatric medications to a variety of mental illnesses, research and education are needed to ensure that the uses are appropriate."

The study looked at the prescription patterns for three major types of psychiatric drugs: antipsychotic drugs, antidepressant drugs, and anti-anxiety drugs, but did not evaluate clinical appropriateness per se.

The study found that antipsychotic drugs were prescribed for psychiatric conditions 99 percent of the time, including mood disorders (39 percent), schizophrenia or other psychotic disorders (35 percent), cognitive disorders such as dementia (7.4 percent), anxiety (6 percent), and attention-deficit/conduct-disruptive behavior disorders (6 percent).

In terms of antidepressant drugs, the study found that 93 percent of prescriptions were for psychiatric conditions, primarily mood disorders (65 percent), anxiety (16 percent), schizophrenia, and other psychotic disorders (2.6 percent). Other non-psychiatric diagnoses for which antidepressants were prescribed included headaches (1.1 percent), connective tissue disease (e.g., fibromyalgia) (1 percent), and back problems (0.7 percent).

Although the study found that the majority of prescriptions written for anti-anxiety medication were used to treat psychiatric conditions (72 percent), a significant percentage (28 percent) were used to for non-psychiatric diagnoses including anxiety related to medical interventions (6 percent), allergic reactions (4 percent), and back problems (2.5 percent).

The study, conducted by Tami L. Mark, Ph.D. at Thomson Reuters and published in the journal CNS Drugs analyzed data from the 2005 National Disease and Therapeutic Index, a nationally representative survey of about 4,000 U.S. office-based physicians conducted by IMS Health.