Psychiatric Medications Linked To High Number of ER Visits

MedicalResearch.com interview with:
Lee M. Hampton, MD, MSc:
Division of Healthcare Quality Promotion
Centers for Disease Control and Prevention
Atlanta, Georgia

Medical Research: What are the main findings of the study?

Dr. Hampton: The study, which used CDC’s national outpatient adverse drug event surveillance system (NEISS-CADES), found that there are almost 90,000 estimated annual emergency department visits by adults for adverse drug events from therapeutic use of antipsychotics, antidepressants, sedatives and anxiolytics, lithium salts or stimulants between 2009 and 2011. Almost one in five of those emergency department visits (19.3%) resulted in hospitalization. Sedatives and anxiolytics, antidepressants, and antipsychotics each caused 20,000 to 30,000 emergency department visits annually. However, relative to how often each of these types of medications was prescribed at outpatient visits, antipsychotics and lithium salts were more likely to cause emergency department visits for adverse drug events than were sedatives, stimulants, and antidepressants. Antipsychotics caused 3.3 times more emergency department visits for adverse drug events than sedatives, 4.0 times more emergency department visits than stimulants, and 4.9 times more emergency department visits than antidepressants relative to their outpatient use.

Out of the 83 specific drugs the study looked at, ten drugs were implicated in nearly 60% of the emergency department visits for ADEs from therapeutic use of antipsychotics, antidepressants, sedatives and anxiolytics, lithium salts or stimulants. Zolpidem was implicated in nearly 12% of all such emergency department visits and 21% of such emergency department visits involving adults aged 65 years or older, more than any other antipsychotic, antidepressant, sedative or anxiolytic, lithium salt or stimulant.

Medical Research: Were any of the findings unexpected?

Dr. Hampton: We were surprised that almost half (49.4%) of adult emergency department visits for adverse events from the psychiatric drugs we looked at involved patients who were 19-44 years old. That means patients who were 19-44 years old had almost as many emergency department visits for ADEs from therapeutic use of antipsychotics, antidepressants, sedatives and anxiolytics, lithium salts or stimulants as did adults who were 45 years old or older. Even when you take the different age group’s use of these drugs into account, the adults who were 19 to 44 years old had more ED visits for antipsychotic, sedative and anxiolytic, and antidepressant adverse events than did adults 45 to 64 years old or adults who were 65 years old or older.

We are not certain why that was the case, but younger adults may be more likely to visit an ED if they have a problem and ED doctors may be more likely to think a younger patient’s problem was due a drug, in part because a younger patient usually has fewer chronic medical conditions that could also have caused his or her problem. Nevertheless, the large number of ED visits for adverse events from psychiatric drugs among young people shows that adverse events from these drugs are a problem for all age groups, not just the elderly.

Medical Research: What should clinicians and patients take away from your report?

Dr. Hampton: Last year, the leaders of the American Psychiatric Association, psychiatrists’ professional organization, urged doctors to use antipsychotics cautiously and only after exploring the feasibility of using alternate treatments. Our report reinforces that it is important for doctors and patients to heed the warning from the American Psychiatric Association to be cautious in their use of antipsychotics.

Doctors and patients should also be cautious in using zolpidem and other sedatives, particularly because there are many treatment options for insomnia, the condition which zolpidem is intended to treat.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Hampton: There have been many developments over the last few years that could influence how many adverse events from psychiatric medication use occur, ranging from the warnings from the American Psychiatric Association to revisions to the Diagnostic and Statistical Manual used to make psychiatric diagnoses to some of these medications going off patent. It will be useful to track the number of emergency department visits for adverse events from psychiatric drugs changes over time in response to those developments.

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