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Mark Olfson, MD, MPH; Steve C. Marcus, MA; Harold Alan Pincus, MD; Julie M. Zito, PhD; James W. Thompson, MD, MPH; Deborah A. Zarin, MD

Arch Gen Psychiatry. 1998;55:310-316.

Background  The authors examined recent changes in the number and proportion of patients prescribed antidepressants by psychiatrists in outpatient private practice and characterized antidepressant prescription patterns by patient age, sex, race, payment source, and clinical diagnosis.

Methods  The authors analyzed physician-reported data from the 1985 and 1993-1994 National Ambulatory Medical Care Survey, focusing on visits to physicians specializing in psychiatry. Logistic regressions were used to examine associations between survey year and antidepressant prescription, adjusting for the presence of other variables.

Results  The proportion of outpatient psychiatric visits in which an antidepressant was prescribed increased from 23.1% (95% confidence interval [CI], 19.7%-26.5%) in 1985 to 48.6% (95% CI, 47.5%-49.7%) in 1993-1994. After controlling for several patient variables, psychiatric patients were approximately 2.3 (95% CI, 1.8-2.9) times more likely to receive an antidepressant in 1993-1994 than in 1985. In 1993-1994, selective serotonin reuptake inhibitors accounted for approximately half of the psychiatric visits with an antidepressant prescription. Increases in the rate of antidepressant prescription were particularly evident for children and young adults; whites; new patients; and patients with adjustment disorders, personality disorders, depression not otherwise specified or dysthymia, and some anxiety disorders.

Conclusions  During the late 1980s and early 1990s, there was a significant increase in the prescription of antidepressants by office-based psychiatrists. This increase was greatest for patients with less severe psychiatric disorders.

From the New York State Psychiatric Institute/ Department of Psychiatry, College of Physicians & Surgeons of Columbia University, New York (Dr Olfson); Western Psychiatric Institute and Clinic, Pittsburgh, Pa (Mr Marcus); Office of Research, American Psychiatric Association, Washington, DC (Drs Pincus and Zarin); and the Schools of Pharmacy and Medicine (Dr Zito) and the Department of Psychiatry, School of Medicine (Dr Thompson), University of Maryland, Baltimore.

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