Antidepressant Prescribing Disparities

A new study finds significant disparities in how patients with major depressive disorder are treated based on ethnic background and type of insurance coverage.

Patients with major depressive disorder (MDD) are prescribed antidepressants in general and newer antidepressants in particular at widely varying rates depending on their race and ethnicity and type of insurance coverage, according to the results of a recent study published in the International Journal of Psychiatry in Medicine. The retrospective, cross-sectional study draws on nationally representative data from the National Ambulatory Medical Care Survey collected between 1993 and 2007.

Medication available to treat MDD includes older drugs such as tricyclic antidepressants and monoamine oxidase inhibitors and newer drugs such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SRNIs). The newer drugs are generally considered to have greater efficacy and fewer side effects.

Patients in the study were 46 years old on average. 52.1% of the study population was covered by private insurance for MDD-related health care, 14.0% was covered by Medicare, and 11.2% by Medicaid. 71.2% of the population was prescribed at least one antidepressant, 40.2% was treated with SSRIs or SRNIs, 10.6% with other new antidepressants, 8.7% with older antidepressants, and 40.6% with combined pharmacotherapy.

According to the study’s results, non-Hispanic white and non-Hispanic black patients with MDD were more likely to be prescribed antidepressants than Hispanics (odds ratios of 1.52 and 1.49, respectively). MDD patients with Medicare or Medicaid were less likely than those with private insurance to be prescribed any antidepressant (odds ratios of 0.69 and 0.62, respectively). In addition, MDD patients with Medicare or Medicaid who did receive antidepressants were less likely than those with private insurance to be prescribed newer antidepressants (relative risk ratios of 0.42 and 0.39, respectively).

To read the study, click here. (Registration required to access full text.)