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Use of Prescription Psychoactive Drugs in Medicaid, 1995

Jeffrey A. Buck
Kay Miller

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center For Mental Health Services

ACKNOWLEDGEMENTS
Jeffrey A. Buck is with the Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration. Kay Miller is with The MEDSTAT Group. Eva Witt and Jon Blake of The MEDSTAT Group contributed valuable computer programming assistance in creating these tables.

This report would not have been possible without the assistance and support of the Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services (DHHS).

DISCLAIMER
Material for this report was prepared under contract by The MEDSTAT Group for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (DHHS). The content of this publication does not necessarily reflect the views or policies of CMHS, SAMHSA, or DHHS.

PUBLIC DOMAIN NOTICE
All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA or CMHS. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, DHHS.

ELECTRONIC ACCESS AND COPIES OF PUBLICATION
This publication can be accessed electronically through the following Internet World Wide Web connection: www.samhsa.gov. For additional free copies or this document, please call SAMHSA's National Mental Health Information Center at 1-800-789-2647.

RECOMMENDED CITATION
Buck, J.A. and Miller, K. Use of Prescription Psychoactive Drugs in Medicaid, 1995. DHHS Pub. No. (SMA) 02-3712. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2002.

ORIGINATING OFFICE
Office of the Associate Director for Organization and Financing, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, 15-87, Rockville, MD 20857.

DHHS Publication No. (SMA) 02-3712
Printed 2002

CONTENTS

• Introduction
• 1995 Table Notes
  • Identification of Prescription Psychoactive Drugs
  • Population Selection Criteria
  • Definition of Terms
  • Exclusions
  • Categorization Variables
  • Description of Tables
  • Data Quality Review
  • Reasonability Analysis
  
  
  
• Tables (1995)
  • All States
  • Alabama
  • Arkansas
  • Delaware
  • Georgia
  • Kansas
  • Kentucky
  • New Hampshire
  • New Jersey
  • Vermont
  • Wyoming

Introduction

The Medicaid program accounts for one-third of public spending for mental health and substance abuse (MH/SA) treatment (Mark et al., 2000). Because it partly focuses on those with disabilities, it is a particularly important program for adults with serious mental illness and children with serious emotional disturbance.

Despite the importance of the Medicaid program, only a few studies have examined MH/SA services within one or more States. One study of 1984 Michigan and California data found that spending for alcohol, drug abuse, and mental health services was 11 to 12 percent of total Medicaid expenditures. Persons using such services accounted for 9 to 10 percent of the Medicaid population (Wright & Buck, 1991). An update of this study using 1992 data found that MH/SA recipients were 7 to 9 percent of enrollees (Wright, Smolkin, & Bencio, 1995). More recently, Larson and colleagues (1998) examined Medicaid MH/SA services use for Michigan, New Jersey, and Washington for 1993. Using a broad definition of MH/SA utilization, this study found that 11 to 13 percent of enrollees had some MH/SA use.

Prescription drugs are an important modality of treatment for MH/SA disorders. Nevertheless, neither these studies nor others have provided much detail about the characteristics of such treatment. To provide information on drug use, a set of Medicaid prescription psychoactive drug statistical tables was developed for the non-elderly population, based on Medicaid data that States submit to the Centers for Medicare and Medicaid Services (CMS, formerly the Health Care Financing Administration). These statistics are presented in a uniform set of tables for each of 10 selected States, plus a set of tables that aggregates data across all 10 States. The tables provide a range of information on users, drug claims, and expenditures for each State. The fundamental purpose is to provide policy makers, interest groups, and others with basic information on prescription psychoactive drug use in Medicaid, and associated trends.

States were selected for analysis based on geographic diversity, completeness and quality of data, and limited penetration of Medicaid managed care. This latter criterion was included because Medicaid managed care data generally reflect only capitation payments for managed care enrollees, and do not allow classification of services or expenditures by diagnosis. Within each State's files, certain individuals were excluded from analysis. These exclusions were most commonly due to the lack of information that would allow a complete picture of service utilization and expenditures. Individuals falling into the following categories were excluded:

1. Dually eligible for Medicaid and Medicare (mostly elderly);
2. Aged 65 and over;
3. Enrolled in capitated (managed care) plans; or
4. Missing sex or date of birth.

The tables in this publication focus on the use of psychoactive drugs, which were identified using the REDBOOK® ¹ classification system. This system allows for the selection and categorization of these drugs by linking the national drug code (NDC) from the claims with the REDBOOK® database.

Tables 6 - 9 focus on the prescription psychoactive drug users who also use MH/SA services. Other information about these MH/SA service users are reported in Mental Health and Substance Abuse Services in Medicaid, 1995 (Buck & Miller, 2002). MH/SA services were identified through a primary MH/SA diagnosis or category of service indicating MH/SA specialty care. Previous work has shown that primary diagnosis alone accounts for about 95 percent of cases identified through more sophisticated methods (Wright & Buck, 1991). Diagnoses were those considered by most payers to be MH/SA conditions (ICD-9 codes 291-292, 295, 296, 297-299, and 300-314). These did not include Alzheimer's disease, other dementias and cognitive disorders; mental retardation and developmental delays; medical conditions related to alcohol or drug disorders (e.g., alcoholic cirrhosis of liver); or MH/SA-related V codes (e.g., observation for mental conditions). MH/SA categories of service were inpatient psychiatric services for 21 and under, and institutional psychiatric care for the aged.

General Recommendations for Using Tables

In the following sections, notes are provided on terminology, selection criteria, categorization variables, table descriptions, and data quality issues. Users of these tables should review this material with particular attention to the following:

1. Users should exercise caution in interpreting these statistics. Tables are based on data that States submit to CMS and that have not been validated in any way. Where possible, notes identify anomalies or other issues to be aware of when interpreting the statistics. However, possible causes of these anomalies have not been investigated.
   
   
2. Some tables may be difficult to understand at first glance. An effort has been made to provide necessary explanatory material within each table. Nevertheless, users should review term definitions and table-specific comments to ensure proper interpretation of the statistics. Sometimes definitions may vary slightly across tables (e.g., the definition of a "user").
   
   
3. In some tables, comparisons are made to all Medicaid prescription drug users in the State who met the inclusion criteria (including psychoactive drug users), regardless of diagnosis or service use. These are referred to as "total prescription drug users," and their associated claims as "total prescription drug claims" and associated expenditures as "total prescription drug expenditures." These categories constitute the denominator for some percentages.
   
   
4. Some care also should be taken when comparing statistics for 1995 with those published for 1994, 1993, 1992, or 1986-1992. Sometimes changes over time can be attributed to changes in category definitions rather than to changes in patterns of care. For example, both the Type of Service and Basis of Eligibility categories are subject to change on a yearly basis.
5. Tables 6 - 9 provide statistics on prescription psychoactive drug use for persons using MH/SA services. Characteristics of these individuals and their MH/SA service use are provided in Buck and Miller (2002).

References

Buck, J.A., Miller, K., & Bae, J. (2000a). Mental Health and Substance Abuse Services in Medicaid, 1986-1992. DHHS Pub. No. (SMA) 99-3366. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.

Buck, J.A., Miller, K., & Bae, J. (2000b). Mental Health and Substance Abuse Services in Medicaid, 1992. DHHS Pub. No. (SMA) 99-3367. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.

Buck, J.A., Miller, K., & Bae, J. (2000c). Mental Health and Substance Abuse Services in Medicaid, 1993. DHHS Pub. No. (SMA) 99-3368. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.

Buck, J. A., Miller, K., & Bae, J. (2000d). Mental Health and Substance Abuse Services in Medicaid, 1994. DHHS Pub. No. (SMA) 00-3284. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.

Buck, J. A. & Miller, K. (2002). Mental Health and Substance Abuse Services in Medicaid, 1995. DHHS Pub. No. SMA 02-3713. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.

Harwood, H. J., Fountain, D., & Livermore, G. (1998). The Economic Costs of Alcohol and Drug Use in the United States. NIDA & NIAAA report, US Department of Health and Human Services, Washington, D.C.: US Government Printing Office.

Larson, M. J., Farrelly, M. C., Hodgkin, D., Miller, K., Lubalin, J. S., Witt, E., McQuay, L., Simpson, J., Pepitone, A., Keme, A., & Manderscheid, R. W. (1998). Payments and use of services for mental health, alcohol, and other drug abuse disorders: Estimates from Medicare, Medicaid, and private health plans. In Manderscheid, R. and Henderson, M., (Eds.), Mental Health, United States, 1998 (pp. 124-141). DHHS Pub. No. (SMA) 99-3285. Washington, DC: U.S. Government Printing Office.

Mark, T., Coffey, R. M., King, E., Harwood, H., McKusick, D., Genuardi, J., Dilonardo, J., & Buck, J. A. (2000). Spending on mental health and substance abuse treatment, 1987-1997. Health Affairs, 19(4), 108-120.

Wright, G. E. & Buck, J. A. (1991). Medicaid support of alcohol, drug abuse, and mental health services. Health Care Financing Review, 13, 117-128.

Wright, G., Smolkin, S., & Bencio, D. (1995). Medicaid Mental Health and Substance Abuse 1992 Use and Expenditure Estimates for Michigan and California: Final Report. Ref. no. 8231, Washington DC: Mathematica Policy Research.

1995 Medicaid Prescription Psychoactive Drug Table Notes

A set of nine tables provides an overview of Medicaid prescription drug utilization and expenditures for people taking prescription psychoactive drugs during calendar year 1995. Tables 6 - 9 focus on these users who also are being treated for mental health and/or substance abuse (MH/SA) conditions. Each set of tables was created for 10 states both separately and as part of an "All States" table set. The data were derived from the Centers for Medicare and Medicaid Services' (CMS's) State Medicaid Research File (SMRF) database. These tables supplement a previously created table set (Buck & Miller, 2002) providing information on Medicaid beneficiaries being treated for mental health and/or substance abuse (MH/SA) conditions during calendar year 1995.

This section describes the definitions and methodologies used to create the tables. It compiles all decisions made during the design process to help users understand the data and how the tables were created. It contains the following sections:

• Identification of Psychoactive Drugs
• Population Selection Criteria
• Definition of Terms
• Exclusions
• Categorization Variables
• Description of Tables
• Data Quality Review
• Reasonability Analysis

Identification of Prescription Psychoactive Drugs

The prescription psychoactive drugs selected include not only psychotropic drugs but also two substance abuse treatment drugs: methadone and antabuse. The REDBOOK® classification system was used to group psychoactive drugs into major categories as well to identify specific antidepressant and antipsychotic medications. The REDBOOK® classification system allowed us to map specific national drug codes (NDCs) into these categories of interest. For the basic breakdown of psychoactive drugs used in these tables, see Figure 1.

Figure 1: Categories of Psychoactive Drugs

Psychotropic Drugs

• Antidepressants
• Antipsychotics
• Barbiturates
• Benzodiazepines²
• Lithium
• Other Anxiolytics/Sedatives/Hypnotics
• Stimulants

Substance Abuse Treatment Drugs

• Substance Abuse Treatment Drugs
• Methadone
• Antabuse

In some of the tables we have added additional categories:

• Users of multiple prescription psychoactive drug types,
• Users of multiple prescription psychoactive drugs (regardless of drug type) and,
• MH/SA users without psychoactive drug use (Tables 6 - 9 only).

Population Selection Criteria

For the first five tables, the population includes only those people who had at least one claim for prescription psychoactive drugs within the calendar year (see Figure 1). The last four tables focus on those people also receiving MH/SA services [see Buck & Miller (2002) for additional information on this population]. The definition of MH/SA is the same used for companion table set. The intent of these tables is to present utilization and expenditure statistics using a conservative and easily interpreted definition of the MH/SA population rather than a broader and potentially more complicated one. The goal of this selection process was to find people who were being treated for a MH/SA condition, not to find every person with a MH/SA condition. To this end, no secondary diagnosis codes were used. Because not all claims carried a diagnosis code, the definition was expanded to include Type of Service codes. Therefore, the person/claim was classified as MH/SA if any one of the following criteria were present:

Figure 2: Description of Diagnosis Codes Included

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Definition of Terms

Crossovers
People dually enrolled in Medicaid and Medicare with at least one claim during the calendar year paid by both payers.

Users
Counts of people who met the criteria defined on each table (e.g., psychoactive drug users or psychoactive drug users within the MH/SA user population). No adjustments are made in user counts for partial year enrollees/recipients (thus, a person counts once regardless of length of enrollment). Identification numbers used in these files are unique to an enrollee regardless of gaps in enrollment.

Expenditures
Medicaid payments, shown in thousands of dollars.

Claims
The number of prescriptions filled (both originals and refills) by the claimant in the calendar year.

Exclusions
Certain populations were excluded from these tables. The most important reason was the absence of complete data for these populations that would prevent a full picture of their utilization. While these tables are designed to represent full utilization and expenditures for the populations included, they may not fully represent an entire state's Medicaid population. The following are the population groups excluded and the basic reason for exclusion (Figure 3 gives the counts of people excluded, by state, for each category):

Figure 3: Number of Enrollees Excluded from Full Medicaid Population

Because a person could fall into more than one category, the above counts are listed in the order in which the rules were applied (in order of priority) to ensure against duplication.

1. Crossover Recipients: Crossover recipients are excluded because their expenditures would not reflect the total cost of their care. For these recipients, Medicare is their primary payer and, therefore, the Medicaid expenditures would represent only those services not covered by Medicare either in total or in part. Also, the quality of data on crossover claim is usually of a lower quality than non-crossover claims.
   
   
2. Enrollees age 65 and over: Those enrollees over 65 who are not crossovers (see above) would not truly reflect those people in this population group. In most cases, they represent a very small percentage of the over 65 enrollees. It was felt that the data would be more accurate if they were excluded.
   
   
3. People who enrolled in capitated plans at any time during the year: Encounter data was not available for those services received under capitated arrangements. The only services included in the data available would be those services that occurred during months they were not enrolled in managed care, fees related to their managed care (premium payments, etc.) and services outside of the managed care program that were paid fee-for-service. Therefore, the services that would be reported would not fully reflect their health care under Medicaid. Nationally, CMS reports that 28 percent of the Medicaid population was enrolled in managed care in 1995, although not all of these managed care programs included capitation payments.
   
   
4. People who had no enrollment during the year (ineligible recipients): There are situations in some states where claims are adjudicated without a valid eligibility record (e.g., retroactive eligibility, manual adjudication, etc). For these situations, no eligibility record exists, therefore, demographic information was not available for these recipients. Because a number of tables give breakdowns by basic demographic categories, it was decided to exclude them. The numbers here are very small (< 1% of total enrollees in most cases).
   
   
5. Enrollees with missing date of birth or sex: The reasons for exclusion here are the same as the category above.

Categorization Variables

Age Group
Age is computed using the date of birth. It reflects the age of the recipient/enrollee on December 31 of the file year. The following groupings are used for reporting age:

Note: People 65 years of age or older are excluded from these tables as well as those with unknown dates of birth.

Sex
Male Female

Note: People whose gender is unknown are excluded from these tables.

Psychoactive Drug Type
Each NDC code for a psychoactive drug was assigned to a drug type based on the REDBOOK® classification system. For the categories used, see Figure 1 in the section above entitled Identification of Psychoactive Drugs.

Individual Drug
In two tables, antidepressants and antipsychotics are broken down into the specific individual drugs as shown in Figure 4.

Figure 4: Specific Drugs within Antidepressant and Antipsychotic Drug Types

Diagnostic Category
Each recipient was assigned to a diagnostic category based on their most frequent diagnosis category in a year. In case of a tie, each file type was inspected to find the first MH/SA diagnosis code assigned to a claim. The files were evaluated in the following order: Inpatient, Outpatient and Long Term Care. Therefore, in the case of a tie, if one or more MH/SA claims were found on the Inpatient file, the first one occurring in the year based on date of service was used. If no MH/SA diagnosis was found on the Inpatient file, the same criteria were applied to the Outpatient file, etc. The diagnostic categories used are shown in Figure 2.

Description of Tables

Table 1: Prescription Psychoactive and All Prescription Drug Use by Sex and Age Group
This table gives a broad overview of the population reflected in this table set. It looks at the number of prescription psychoactive drug users and the associated claims and expenditures by sex and age group. It then compares these to total prescription drug use for the full Medicaid population, with the same exclusions applied as applied to the psychoactive drug user population.

Table 2: Prescription Psychoactive Drug Users by Drug Type and Age Group
This table looks at the prescription psychoactive drug use by drug type across the various age groups. It shows the number of users and the percent of each age group that used the specific type of psychoactive drug.

Table 3: Prescription Psychoactive Drug Expenditures by Drug Type and Age Group
This table is similar to Table 2 except that it looks at expenditures instead of users.

Table 4: Antidepressant Drug Use by Individual Drug
This table takes a subset of the psychoactive drug users, those that take antidepressant drugs and breaks down their use by the individual antidepressant drug. As with Table 1, it looks at this use in terms of users, claims and expenditures. It also identifies those users who took more than one antidepressant drug during the calendar year. See the list of individual drugs in the Definition of Terms section of this document (Figure 4).

Table 5: Antipsychotic Drug Use by Individual Drug
This table is similar to Table 4, except that it looks at users of prescription antipsychotic medication instead of antidepressants.

Table 6: Prescription Psychoactive Drug Use by Sex and Age Group within the MH/SA User Population
This is similar to Table 1, except that it subsets the population to include only the prescription psychoactive drug users who also have MH/SA service use. It also shows the percentage of MH/SA service users that take prescription psychoactive medications, and the percentage of all prescription drug claims for this group that are represented by psychoactive medications. This population also provides the basis for Tables 7 - 9. More information about it is reported in Buck and Miller (2002).

Table 7: Prescription Psychoactive Drug Users by Drug Type and Age Group with the MH/SA User Population
This table is similar to Table 2, except that is focuses only on prescription psychoactive drug users who also have MH/SA services use.

Table 8: Percent of MH/SA Users under Age 21 with Prescription Psychoactive Drug Use by Diagnostic Category and Drug Type
This table looks at MH/SA service users under age 21 with prescription psychoactive drug use within broad diagnostic categories as well as subsets therein. The numbers reported are the percentages within each diagnostic category that take the various psychoactive drugs (e.g., number of schizophrenics taking antidepressant medications).

Table 9: Percent of MH/SA Users Aged 21 - 64 with Prescription Psychoactive Drug Use by Diagnostic Category and Drug Type
This table is the same as Table 8 only focusing on the population age 21 to 64 rather than under age 21.

Data Quality Review
This section describes areas that require further explanation or problems that were encountered during the creation of these tables.

There were no specific problems encountered during processing. The one data quality check that was not done, given the method used for identifying the psychoactive drugs, was checking the level of unmapped drug codes in the drug claims files as compared with the full REDBOOK® database. Only the NDC codes specific to psychoactive drugs were linked, so there was no way of telling how complete the REDBOOK® data was compared with the NDC codes observed on the State's claims files. There is always a possibility that some psychoactive drugs were not included in the REDBOOK® database.

Reasonability Analysis
As noted earlier, statistics presented in these tables have not been validated in any way. However, they were reviewed for basic reasonableness, using a cross-state review process. Selected columns from selected tables for each state were combined together to allow review of the same statistics across states. While users always should be aware of anomalies resulting from small cell sizes, other discrepancies also are noted below.

Table 1
The results appeared to be reasonable across states. The ranges in percentages across states showed no outliers. The percent of the psychoactive drug users who also have a MH/SA condition ranges from 41.7% in Alabama to 60.9% in New Hampshire. The percent of total drug users who use prescription psychoactive drugs ranges from 16.1% in Georgia and Wyoming to 22.4% in Arkansas.

Table 2
The most frequently used drug type across all psychotropic drug users was consistent across all states with only minor variations in Georgia and New Jersey. Figure 5 shows the first and second most frequently occurring psychoactive drug type across the All States table set:

Figure 5: Two Most Frequently Used Psychoactive Drug Types - All States Combined

All states, except Georgia and New Jersey, had the same pattern of most frequent psychoactive drugs. In Georgia, because of the larger under 6 population, the most frequent across all age groups was the "Other Anxiolytics/Sedatives/ Hypnotics" category. In New Jersey, the most frequent among the 45-64 population were "Benzodiazapines" and across all ages was "Other Anxiolytics/Sedatives/Hypnotics".

When looking at the second most common drug type, the distribution within states is much more varied but nothing looked unreasonable. Figure 7 shows the variations across states:

Figure 7: Second Most Frequently Occurring Psychoactive Drug Type

Key:

1. Antidepressants
   
2. Antipsychotics
   
3. Barbiturates
   
4. Benzodiazepines
   
5. Lithium
   
6. Other Anxiolytics/Sedatives/Hypnotics
   
7. Stimulants

Table 3
The patterns identified in Table 2 are similar to those found in Table 3, but there is variation. For example, the most common drug in the under 6 age group is Other Anxiolytics/Sedatives/Hypnotics (76.3% of users, but only 30.1% of cost), but the most expensive is Stimulants (37.9% of cost, but only 12.3% of users).

When looking at the patterns across states for the total age group, three states have very different patterns between users and expenditures. In Georgia, Other Anxiolytics/Sedatives/Hypnotics make up 43.6 % of the users, but only 9.2% of the expenditures. A similar pattern exists for this drug type in New Jersey (36.9% of users but only 8.9% of expenditures). In Kansas, Antipsychotics make up 40.6% of the expenditures but only account for 22.9% of users.

Table 4
The issue to consider when looking at this table is the augmentation of the newer antidepressant medications in 1998 and the types of drugs carried on the state's formularies in 1995. The newer antidepressants³, including the serotonin reuptake inhibitors (SSRIs) and other drugs such as venlafaxine, buprompion, nefazadone and mirtazapine are not found with much prevalence (if at all) in the 1995 Medicaid files. The rows have remained in the tables as a reminder of what medications are not yet prevalent in these populations. There was no drug that was found in one state but not in others, but there are four drugs not found at all in these data: Bupropion, Citalopram, Isocarboxazid, and Mirtazapine. There are another six that had fewer than 1000 total users across all states: Amoxapine (546), Maprotioline (265), Phenelzine (187), Protriptyline (257), Tranylcypromine (47) and Trimipramine (240).

Table 5
As with the antidepressants, there are three newer antipsychotic medications that were not expected to appear with high frequency. The first two, Olanzapine and Quetiapine, do not occur at all in any state. However, Risperidone does occur more frequently than expected (over 11 thousand across all three states). In addition to these, there are another four drugs that are used by fewer than 1000 claimants across all states: Droperidol (17), Pimozide (253), Prochlorperazine (47) and Promazine (9).

Table 6
To assess the reasonability of this table, it was examined from two perspectives. How did the percentage of psychoactive drug users who use MH/SA services compare across states and how did the percentage of MH/SA service users who had a psychoactive drug compare across states? The results were fairly consistent across states. The percentage of drug users who are MH/SA ranged from 41.7% in Alabama to 60.9% in New Hampshire while the percentage of MH/SA users who used prescription psychoactive drugs ranged from 44.7% in Vermont to 69.4% in Alabama.

Table 7
This table was examined to see how the distribution of drugs varies from the general population who use prescription psychoactive drugs to the MH/SA population who use these drugs. Figure 9 shows the variation between these to populations across the different drug types. While the most common drug type within both populations is antidepressants, the distributions between the two are very different in some categories (e.g., Antipsychotics, Other Anxiolytics/Sedatives/ Hypnotics).

Figure 9: Percent of Prescription Psychoactive Drug Users by Drug Type and Population (All States Combined)

Table 8
The use by disease category showed generally low percentages of any specific medication except in expected categories. Within the children's population represented in this table, 47.4% of those with major depression and other affective psychoses took antidepressants; 48.9% of those with other psychoses took antipsychotics and 72.0% of those with hyperkinetic syndrome took stimulants, which includes drugs like Ritalin.

Table 9
The same patterns described in Table 8 also apply here. For this adult population (aged 21-64), the high percentages included 70.6% of those with major depression and other affective psychoses used antidepressants and 61.3% of those with other psychoses used antipsychotic medication. Although this population was adults, 25.4% reporting hyperkinetic syndrome used stimulants.

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SMA02-3712