by Katherine Bindley, Huffington Post
When it comes to feeling depressed or anxious, or inattentive, women are more likely to take prescription medication than men, according to a new report from Medco Health Solutions, the pharmacy-benefit manager.
One of the more startling statistics in the report, which analyzed prescription claims data from 2.5 million insured Americans from 2001 to 2010, is that one in four women is dispensed medication for a mental health condition, compared to just 15 percent of men.
Antidepressant use especially is high among women, up 29 percent since 2001, the report showed, and anti-anxiety meds are used by women at almost twice the rate seen among men.
There’s also a gender shift when it comes to the use of drugs for ADHD in adulthood: although the disorder is thought to afflict primarily young boys, slightly more women use ADHD medications as adults than men.
The use of atypical antipsychotics — medications once mainly prescribed for schizophrenia — have gone up dramatically as well. The number of adults ages 20 to 64 taking these meds is 3.5 times higher than it was 2001.
And although the number of men on these drugs increased more dramatically during that time, there are still more women than men taking the medications.
Dr. David Muzina, a psychiatrist and national practice leader of the Medco Neuroscience Therapeutic Resource Center, took The Huffington Post through the study’s results and what they mean.
One in four women is on antidepressants, and women are using — or at least prescribed — these medications at higher rates than men. Any idea why that’s happening?
In general, we know that women tend to seek treatment and go to doctors’ offices more frequently than men do.
When you move into the behavioral health space, that may be even more true, so the opportunity to get evaluated and diagnosed and treated is likely higher. That may, to some extent, explain some of the differences.
We also believe that [women] may be at higher risk for major depressive disorders. It likely is biological. We don’t know exactly why.
I can speak from experience as a practicing psychiatrist, comparing a general visit between a psychiatrist and a woman versus a male patient, that there is more resistance and reluctance from the men to be willing to accept treatment.
There may be some subtle differences there with men thinking they need to tough it out.
Women are using anti‐anxiety medication at more than twice the rate of men. Why is that?
[Anti-anxiety medications] are fast-acting. They’re in that Valium family, and they’re very commonly used to treat adjustment disorders — these brief periods of time for a month or two when someone has life stressors and is having difficulty coping.
An example would be a marital discord, going through a separation or a divorce. A job would be a big one, particularly in the current economy.
Women are bearing the brunt of the emotional stressors around us: they’re working, raising the kids, trying to juggle all these issues, getting all these things done, and they’re more likely to reach out and ask for help.
Is there any relationship between the increase in female antidepressant use and the increase in anti-anxiety use?
I think that this [gender] difference likely mirrors what we’re seeing with the depression medications to some extent.
Anxiety disorders are completely different than mood disorders but [there is an] overwhelming frequency with which you see them on top of existing depression.
Typically we think of boys being more affected by ADHD, but there’s gender shift in the use of ADHD medications in adulthood. What’s going on there?
We’ve seen an increased recognition [in psychiatry] that the condition is present in adults. An anecdotal interpretation on my behalf is, think about who takes kids to their doctors appointments and who is making sure their medications go to the school? It’s almost always the moms.
My thinking around this that the women are more in touch with what’s going on with their kids, so they’re perhaps recognizing, ‘Wait, I have these symptoms as well,’ or ‘I did when I was a kid.’ They’re more likely to have a conversation with their kids’ doctors.
Additionally, the hyperactive form of this disorder is more easily recognized in boys and girls tend to have the inattentive form.
In the classroom, quietly inattentive doesn’t cause problems like the hyperactive interruptive boy might. So it may be easier for [girls] to slip through the cracks in school, and then [the disorder] may become clearer in adult life.
How about the data on women’s use of atypical antipsychotics? Why have these numbers grown so much?
Initially, atypical antipsychotics came on the market as treatment for schizophrenia. Subsequent studies have demonstrated their efficacy in treating bipolar disorder, primary the manic part of the illness.
More recently, a couple of these antipsychotics have also been studied in terms of treating major depressive disorder, as an add-on to other depression medications.
So they’ve been expanding the indications for these medications. Since we’ve found that several of these medications, when added to depression medications, can make the treatment more likely to be effective, and since women are more likely to be on antidepressants, you can connect the dots.
What do you think these numbers indicate about our overall relationship with psychiatric medications in this country?
We see this increase in medication use, and it’s a trend over time. Something’s going on there. We recognize that, particularly in America, we tend to like our fast-fixes.
If there’s a pill for something, that might be the easier, faster approach than talking it through or exercising.
And then there have been studies that have shown that over the last decade, there’s been a decrease in the utilization of psychotherapy — also known as counseling and talk therapy — for mental health disorders.
When you match those lines — an increase in drug use and a decrease in psychotherapy use — we’re tending to look to medications a bit more than before.
So it’s important in looking at this data that we step back and think very carefully about making these diagnoses, prescribing these medications and then monitoring them for safety and effectiveness, because there are other non-medication approaches that are helpful.
What should doctors and patients take away from this report?
All drugs they come with risk. When I see numbers like this, with an increased trend, it emphasizes the importance that both patients and their doctors are aware of the risks of these medications.
For example, with antidepressant medications in young adults, there is a risk early on of an increase in suicidal thoughts and perhaps suicidal behavior that clearly needs to be monitored very closely.
The other example would be with the atypical antipsychotics, which have been associated with an increase in cholesterol. There’s an association with Type 2 diabetes, and it can be a very rapid onset. Thinking about the overall health risks is crucial.
Is there any evidence that these medications are helping women?
I don’t know that it’s definitely making them happier or more functional. What I would say is that these are effective treatments when someone is correctly diagnosed, receives the right medication, at the right dose, for the right duration of time.
They can make a dramatic difference. In those cases, absolutely yes, they’re helping women.