More patients with anxiety disorders are being prescribed antipsychotic medications by office-based psychiatrists
Research Activities, August 2012, No. 384
Antipsychotic agents are increasingly being used to treat a wide range of conditions. Their increased use is due to the ever-expanding Food and Drug Administration's approved indications as well as their inherent sedation properties. This quality has made them attractive in patients with treatment-resistant anxiety disorders. While there is a dearth of information about their effectiveness for anxiety disorders, a new study finds that the use of antipsychotics to treat these conditions has risen dramatically.
Researchers analyzed data over a 12-year period from the National Ambulatory Medical Care Survey that contains information from patient visits to office-based physicians. The sample for this study included 4,166 visits to psychiatrists where there was a diagnosis of an anxiety disorder, including traumatic stress disorders, panic disorders, phobias, and generalized anxiety disorder. Up to six medications mentioned on the medical records were captured, including antipsychotic agents.
Psychiatric visits where an anxiety disorder was diagnosed increased from 21.2 percent in 1996-1999 to 25.7 percent in 2004-2007. During the 12-year study period, prescriptions for antipsychotics during visits in which anxiety disorders were diagnosed doubled from 10.6 percent to 21.3 percent. Most of the increase in this prescribing trend occurred among new patients. Patient characteristics particularly associated with antipsychotic prescribing included younger age, being black, having public insurance, and the presence of a coexisting condition. The biggest jump in antipsychotic prescriptions occurred in patients with panic disorder. Given the side effect profiles of antipsychotics, which can carry metabolic, endocrine, and cerebrovascular risks, the researchers suggest that clinicians limit their use to patients where there is a clear indication. The study was supported in part by the Agency for Healthcare Research and Quality (HS16097).
See "National trends in the antipsychotic treatment of psychiatric outpatients with anxiety disorders," by Jonathan S. Comer, Ph.D., Ramin Mojtabai, M.D., Ph.D., M.P.H., and Mark Olfson, M.D., M.P.H., in the October 2011 American Journal of Psychiatry 168(10), pp. 1057-1065.