According to an article published online last month in the International Journal of Psychiatry, African-Americans and Hispanics with major depressive disorder are less likely to get antidepressants than Caucasian patients, whilst Medicare and Medicaid patients have a lesser chance of receiving the newest generation of antidepressants.

To gain more insight into Physician’s antidepressant prescribing patterns, researchers from the University of Michigan School of Public Health decided to conduct an analysis in which they evaluated who and what antidepressants were prescribed from data obtained from 1993 to 2007.

They discovered that whoever received a prescription for antidepressants in the first place depended on the patient’s race, payment source and geographical region and on the physician’s ownership status, whilst the patient’s age and payment source influenced which type of antidepressant they received.

Even though Caucasians had a 1.52 times higher chance of receiving a prescription for antidepressants for major depressive disorders compared to Hispanic and African-American patients, the patient’s race proved irrelevant in the physician’s choice of a specific type of antidepressant medication.

Leading researcher, Rajesh Balkrishnan, an associate professor in U-M SPH and principal investigator, who also has an appointment in the College of Pharmacy, declared:

“This study confirmed previous findings that sociological factors, such as race and ethnicity, and patient health insurance status, influence physician prescribing behaviors. This is true in particular for major depressive disorder treatment.”

In comparison with older generation antidepressants, such as TCAs, MAOIs and others who tend to have more side effects, newer types of antidepressants, like SSRI’s and SNRI’s are now considered to be first-line pharmaceutical treatments for major depressive disorders.

Compared with privately insured individuals, 31% fewer Medicare and 38% fewer Medicaid patients were less likely to receive a prescription for antidepressants. However, other factors as to who received antidepressants included geographic location and physician ownership status.

Sole practitioners were 25% less likely to prescribe antidepressants versus non-owners, whilst physicians in metropolitan areas were 27% less likely to prescribe antidepressants in all patients with depression, yet physicians who had previously seen a patients were 1.4 times more likely to prescribe antidepressants.

The study also assessed which patients received the newer antidepressants compared with the older antidepressants, and discovered that the older a patient was, the likelihood of being prescribed with only SSRI/SNRI antidepressants was 7% lower as compared with receiving only older antidepressants. Medicare had a 58% lower chance, and Medicaid patients a 61% lower chance of receiving only newer antidepressants, whilst HMO patients were 2.19 times more likely of being prescribed only other newer antidepressants.

The outcome further revealed that Northeastern physicians were 43% less likely to prescribe only newer antidepressants compared to the West and 43% less likely to prescribe combined therapy for patients.

According to Balkrishnan, the study revealed significant implications for mental health policy. He urged:

“We need policy makers to design interventions to improve physician practice guidelines adherence. This will help eliminate unnecessary variations among physician practices and to obtain optimal health care for patients.”

Written by Petra Rattue