"Too Much, Too Many, Too Young" -- Yet It Continues

Back on December 12, 2009, via the New York Times reporting, we learned that poor kids on Medicaid were four times more likely to be medicated (many for off-label indications -- essentially, a form of "chemical restraints") with powerful anti-psychotic drugs than their wealthier, privately insured counterparts (who, in the main, it seems, were more likely to receive talk therapy).

Now we learn that "psychotropic polypharmacy", or the presecription of more than one powerful psychotropic drug is continuing to rise, across all US patient populations, but especially among Medicaid patients. I wonder how many are receiving New Merck's Saphris^® (Asenapine). Here is the link to that Archives of General Psychiatry study -- and an abstract:

. . . .Results: There was an increase in the number of psychotropic medications prescribed across years; visits with 2 or more medications increased from 42.6% in 1996-1997 to 59.8% in 2005-2006; visits with 3 or more medications increased from 16.9% to 33.2% (both P < .001). The median number of medications prescribed in each visit increased from 1 in 1996-1997 to 2 in 2005-2006 (mean increase: 40.1%). The increasing trend of psychotropic polypharmacy was mostly similar across visits by different patient groups and persisted after controlling for background characteristics. Prescription for 2 or more antidepressants, antipsychotics, sedative-hypnotics, and antidepressant-antipsychotic combinations, but not other combinations, significantly increased across survey years. There was no increase in prescription of mood stabilizer combinations. In multivariate analyses, the odds of receiving 2 or more antidepressants were significantly associated with a diagnosis of major depression (odds ratio [OR], 3.44; 99% confidence interval [CI], 2.58-4.58); 2 or more antipsychotics, with schizophrenia (OR, 6.75; 99% CI, 3.52-12.92); 2 or more mood stabilizers, with bipolar disorder (OR, 15.46; 99% CI, 6.77-35.31); and 2 or more sedative-hypnotics, with anxiety disorders (OR, 2.13; 99% CI, 1.41-3.22).

Conclusions: There has been a recent significant increase in polypharmacy involving antidepressant and antipsychotic medications. While some of these combinations are supported by clinical trials, many are of unproven efficacy. These trends put patients at increased risk of drug-drug interactions with uncertain gains for quality of care and clinical outcomes. . . .

What on Earth do we think we are doing, here?

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^{[Image, above right, derived from a charcoal by artist Charles White, commissioned by the WPA (i.e., public domain) circa early 1940s -- Chicago.]}