P N Pastor, PhD and Henry Xia. OAEHP, CDC/National Center for Health Statistics, 3311 Toledo Rd. Rm. 6423, Hyattsville, MD 20782, (301)458-4422, php3@cdc.gov

Introduction: During the 1990s, antidepressant use in ambulatory care increased rapidly. Expanded use of antidepressants, especially newer drugs such as selective serotonin reuptake inhibitors (SSRIs, e.g. Prozoac®, Paxil®) reflected more treatment for depression and more use of antidepressants to treat other mental and physical disorders. This study examines trends in antidepressant use in ambulatory care for patients with depression, non-depression mental disorders, and no mental disorders. Methods: Nationally representative ambulatory care data are derived from combined survey results of visits to office-based physicians’ practices (National Ambulatory Medical Care Survey) and hospital outpatient departments (National Hospital Ambulatory Medical Care Survey). Results: Between 1993-94 and 1999-2000, the annual number of visits for diagnosed depression increased by 21% to 27 million, visits for non-depression mental disorders by 19% to 36 million, and visits for non-mental disorders by 14% to 811 million. Visits with an SSRI increased even more rapidly: 46% for depression visits, 120% for non-depression mental disorder visits, and 334% for visits without a diagnosed mental disorder. Much of the increased use of SSRIs for depression and other diagnoses reflected wider use of these drugs by primary care physicians, non-psychiatric medical specialists, and hospital outpatient clinics. The 5 fold increase in SSRI visits to primary care physicians by patients without a diagnosed mental disorder suggests more off-label use for subsyndromal mental conditions and other disorders. Conclusion: Between 1993-94 and 1999-2000, the increase in visits with an SSRI resulted from the diffusion of these drugs in non-psychiatric ambulatory care.

Learning Objectives: At the conclusion of the session, the participant will be able to

• Identify recent national trends in the prescription of antidepressants for ambulatory care patients with and without diagnosed depression,
• Describe the factors contributing to the rapid increase in the prescription of antidepressants in non-psychiatric ambulatory care.

Keywords: Depression, Ambulatory Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.