Current Trends of Treatment for Co-Occurring Depression and Anxiety in the United States
Keywords: Stanford University School of Medicine
Community Health and Prevention Research
depression
anxiety
mental health
pharmacology
trends
Thesis

Depression and anxiety disorders together affect over 560 million of the world’s population. While individual diagnoses of depression or anxiety can themselves be extremely debilitating, co-occurring depression and anxiety can be even more problematic. Currently, there is scant data examining patterns and trends in treatment for this combination, This paper fill this need using the National Disease and Therapeutic Index (NDTI) data to explore how treatment differs by physician and patient characteristics.
Methods
Data was extracted from the National Disease and Therapeutic Index (NDTI), which is a nationally representative physician survey produced by IQVIA, Inc. (Plymouth Meeting, PA; formerly IMS Health). We selected patients with a diagnosis of co-occurring depression and anxiety and identified newly prescribed or continued therapies. We then analyzed patterns of antidepressant and sedative medications for different population groups and specifically examined treatment variations by provider specialty: age, gender, and race/ethnicity, and insurance coverage.
Results
Nationally, an estimated 181,000 (95% CI, 174,600-188,300) office-visits occurred in 2018 for patients with co-occurring depression and anxiety. Of those receiving medication treatment for depression and anxiety, the most common therapies were SSRIs (used in 56.6% of patients), antipsychotics (28.6%), newer generation antidepressants (26.0%), SSNRIs (10.6%), benzodiazepines (8.3%), anti-epileptics (6.1%), and non-barbiturate sedatives (4.1%). Furthermore, most patients with comorbid depression and anxiety are prescribed more than one medication simultaneously. For example, within the SSRIs, 100% of patients prescribed fluoxetine, 25.8% of patients on escitalopram, and 58.2% of patients on citalopram were also prescribed other depression/anxiety medications concomitantly. All benzodiazepines, antiepileptics, and non-barbiturates were prescribed alongside other medications as well.
Selection variation was seen between different insurances, though no data was available for patients with Medicaid. Some selection variation was seen between age groups, race/ethnicity, and prescriber specialty. For example, within the age groups 19-39 and 40-59, the highest proportion of patients used SSRIs (67.6%, p < 0.0001 and 60.2%, p < 0.0001). For patients between the ages of 60 and 74, newer generation antidepressants were the most commonly prescribed (58.3%, p < 0.0001), and for those aged 75 and older, SSRIs and newer age antidepressants (57.2%, p < 0.0001) were used more often than antipsychotics (42.8%). With regards to race/ethnicity, all Asian and Hispanic patients surveyed were prescribed SSRIs. In terms of prescriber specialty, most patients treated by primary care physicians including family practice, general practice, internal medicine, and geriatrics were taking newer generation antidepressants (81.7%, p < 0.0001). In comparison, most patients seen by psychiatrists were treated with an SSRI (58.5%, p < 0.0001)