Depression: Implications for State and Local Healthcare Programs

Pharmaceutical Use & Costs

Presenter: David J. Katzelnick, M.D., Clinical Associate Professor of Psychiatry, University of Wisconsin Medical School, Madison, Wisconsin

Research clearly indicates that, although many chronic diseases are treatable, depression often has the most effective outcomes per dollar of treatment. For example, study findings show an 85-percent improvement in functional status for patients diagnosed as depressed for those who are correctly using antidepressive medications or seeking psychotherapeutic treatment.

New medications to treat depression are coming onto the market regularly. This increase is leading to a rise of overall costs for antidepressive medications in the United States ($8.5 billion annually). There has been a dramatic shift in the types of medications that are most commonly prescribed, partly because tricyclic drugs are associated with overdose and negative side effects are common.

Newer medications, such as the selective serotonin reuptake inhibitors (SSRIs), have decreased the incidence of overdose rates and have been shown to be equally effective in treating depression without significant side effects. A reduction in side effects (i.e., blurred vision, constipation, weight gain, cardiac abnormalities) has been shown to dramatically reduce noncompliance rates.

Costs of this new generation of drugs have been shown to be equivalent to costs associated with the older drugs, but the newer drugs do see a more dramatic improvement in patients. Therefore, it seems that high costs are not representative of an increase in cost per individual; in fact, this rise in cost is potentially a function of the fact that more people are being recommended for pharmaceutical treatment than ever before.

References

Greenberg P, et al. Depression: a neglected major illness. J Clin Psychiatry 1993 Nov;54(11):419-24.

Mulrow C, et al. Efficacy of newer medications for treating depression in primary care patients. Am J Med 2000 Jan;108:54-64.

Santiago JM. The costs of treating depression. J Clin Psychiatry 1993 Nov;54(11):425-6.

Simon GE, et al. Patterns of antidepressant use in community practice. Gen Hosp Psychiatry 1993;15:399-408.

Simon GE, et al. Initial antidepressant choice in primary care. JAMA 1996;275(24):1897-902.

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