Prescribing of psychotropic medications to patients without a psychiatric diagnosis

OBJECTIVE This study used a private insurance claims database to examine the use of diverse classes of psychotropic medications among patients without a psychiatric diagnosis. METHODS MarketScan claims data for 2009 were used to identify privately insured individuals who filled a prescription for at least one psychotropic medication (5.1 million patients). Bivariate and multivariate analyses were used to compare the proportion of patients with and without a psychiatric diagnosis who received a prescription for six different classes of psychotropic medications. The analyses were adjusted for potential medical indications and severity of comorbid general medical illness. RESULTS Altogether, 58% of individuals who were prescribed a psychotropic medication in 2009 had no psychiatric diagnosis during the year. The proportion of patients who were prescribed a psychotropic medication without a psychiatric diagnosis was highest among individuals aged 50 to 64 (69%) and among individuals who did not receive any mental health specialty care (67%). The odds of being prescribed psychotropic medication without a psychiatric diagnosis were 2.9 times higher among patients aged 50 to 64 than among younger patients. Diagnoses signifying potential medical indications for use and severity of comorbid medical conditions were only weakly related to absence of a psychiatric diagnosis and did not alter these age trends. CONCLUSIONS In a large private claims database, a majority of recipients of psychotropic medication, especially older patients and those not utilizing mental health specialty care, lacked a clear indication for such use. This phenomenon deserves further study and may reflect less than desirable care.