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zoom RSS 抗うつ剤の使用量は10年で2倍/米国

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 米国での抗うつ剤の使用量は10年で2倍となったが、精神科の受診者数は減り続けている。
 最新のデータによれば、2005年に米国人の約10%、2,700万人が抗うつ剤を服用している。1996年のデータと比較すると2倍となっているというが、服用する理由の半数は背部痛、神経痛、疲労、睡眠障害によるものだという。抗うつ剤服用者で、精神療法を受けている人の割合は31.5%から20%未満まで低下した。患者の約80%は精神科医以外の医師により治療されている。消費者への抗うつ薬の宣伝広告の支出は3200万ドルから1億2200万ドルに増加した。
 2004年にFDA食品医薬品局は、子供では自殺思念のリスクが高まるとの警告をだしたため、翌年使用量が約10%低下した。しかし、それ以前に使用量が増加していたために、2005年の使用率は1996年よりも高かった。
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英国は「真のプロザック国家」
http://kurie.at.webry.info/200802/article_16.html
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Antidepressant Use Doubles in U.S., Study Finds
Many Factors May Have Contributed to Spike, Researchers Say
By Liz Szabo, USA TODAY
Aug. 4, 2009
http://abcnews.go.com/Health/MindMoodNews/story?id=8246738

The number of Americans using antidepressants doubled in only a decade, while the number seeing psychiatrists continued to fall, a study shows.
Number of People on Antidepressants Doubled in 10 years
The number of Americans using antidepressants doubled in only a decade, while the number seeing psychiatrists continued to fall, a study shows.
(Taxi/Getty Images)

About 10 percent of Americans ― or 27 million people ― were taking antidepressants in 2005, the last year for which data were available at the time the study was written. That's about twice the number in 1996, according to the study of nearly 50,000 children and adults in today's Archives of General Psychiatry. Yet the majority weren't being treated for depression. Half of those taking antidepressants used them for back pain, nerve pain, fatigue, sleep difficulties or other problems, the study says.

Among users of antidepressants, the percentage receiving psychotherapy fell from 31.5 percent to less than 20 percent, the study says. About 80 percent of patients were treated by doctors other than psychiatrists.

Patients today may be more likely to ask about antidepressant advertising, says study author Mark Olfson of Columbia University and the New York State Psychiatric Institute. During the study, spending on direct-to-consumer antidepressant ads increased from $32 million to $122 million.

Doctors today also are more comfortable prescribing antidepressants, partly because the newer drugs are safer and cause fewer serious side effects, says James Potash of Johns Hopkins Hospital in Baltimore, who wasn't involved in the study.

David Spiegel of Stanford University School of Medicine says he's glad to see more people getting treatment for depression, which causes more disability than any other medical condition.

But Olfson says his study shows that doctors need more training in mental health. And he says he's concerned about the decline in patients receiving psychotherapy. Patients who receive only medication may not get the help they need, he says.

Many patients are unable to see psychiatrists, however, because of insurance barriers. Many doctors no longer accept insurance because of low reimbursement rates for therapy, Spiegel says. The study ended before the passage of a 2008 law that requires employers with more than 50 workers to provide comparable benefits for mental and medical care.

Antidepressants Can Come With Risks

Studies suggest doctors should be cautious about prescribing antidepressants to children. In 2004, the Food and Drug Administration issued a "black box" warning that the medications could increase the risk of suicidal thoughts in children. Use of antidepressants by children fell nearly 10 percent the next year, according to Olfson's 2008 study of the subject. Antidepressant use had been rising so quickly in the years before the warning, however, that the rate of use in 2005 was still higher than in 1996.

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National Patterns in Antidepressant Medication Treatment

Mark Olfson, MD, MPH; Steven C. Marcus, PhD

Arch Gen Psychiatry. 2009;66(8):848-856.

Context Antidepressants have recently become the most commonly prescribed class of medications in the United States.

Objective To compare sociodemographic and clinical patterns of antidepressant medication treatment in the United States between 1996 and 2005.

Design Analysis of antidepressant use data from the 1996 (n = 18 993) and 2005 (n = 28 445) Medical Expenditure Panel Surveys.

Setting Households in the United States.

Participants Respondents aged 6 years or older who reported receiving at least 1 antidepressant prescription during that calendar year.

Main Outcome Measures Rate of antidepressant use and adjusted rate ratios (ARRs) of year effect on rate of antidepressant use adjusted for age, sex, race/ethnicity, annual family income, self-perceived mental health, and insurance status.

Results The rate of antidepressant treatment increased from 5.84% (95% confidence interval [CI], 5.47-6.23) in 1996 to 10.12% (9.58-10.69) in 2005 (ARR, 1.68; 95% CI, 1.55-1.81), or from 13.3 to 27.0 million persons. Significant increases in antidepressant use were evident across all sociodemographic groups examined, except African Americans (ARR, 1.13; 95% CI, 0.89-1.44), who had comparatively low rates of use in both years (1996, 3.61%; 2005, 4.51%). Although antidepressant treatment increased for Hispanics (ARR, 1.75; 95% CI, 1.60-1.90), it remained comparatively low (1996, 3.72%; 2005, 5.21%). Among antidepressant users, the percentage of patients treated for depression did not significantly change (1996, 26.25% vs 2005, 26.85%; ARR, 0.95; 95% CI, 0.83-1.07), although the percentage of patients receiving antipsychotic medications (5.46% vs 8.86%; ARR, 1.77; 95% CI, 1.31-2.38) increased and those undergoing psychotherapy declined (31.50% vs 19.87%; ARR, 0.65; 95% CI, 0.56-0.72).

Conclusions From 1996 to 2005, there was a marked and broad expansion in antidepressant treatment in the United States, with persisting low rates of treatment among racial/ethnic minorities. During this period, individuals treated with antidepressants became more likely to also receive treatment with antipsychotic medications and less likely to undergo psychotherapy.

Author Affiliations: Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York (Dr Olfson); and School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Dr Marcus).

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