National trends in second-generation antipsychotic augmentation for nonpsychotic depression

Objective: This study estimates national trends and patterns in use of second-generation antipsychotics (SGAs) for adjunctive treatment of nonpsychotic adult depression in office-based practice. Method: Twelve consecutive years (1999-2010) of the National Ambulatory Medical Care Survey were analyzed to estimate trends and patterns of adjunctive SGA treatment for adult (≥ 18 years) nonpsychotic depression in office-based visits. Adjunctive SGA use was examined among all office visits in which depression was diagnosed (N = 7,767), excluding visits with diagnoses for alternative SGA indications (schizophrenia, bipolar disorder, pervasive development disorder, psychotic depression, dementia) and those without an active antidepressant prescription. Results: From 1999 to 2010,8.6% of adult depression visits included an SGA. SGA use rates increased from 4.6% in 1999-2000 to 12.5% in 2009-2010, with an adjusted odds ratio (AOR) for time trend of 2.78 (95% CI, 1.84-4.20). The increase in SGA augmentation was broad-based, with no significant differences in time trends between demographic and clinical subgroups. For the most recent survey years (2005-2010), SGA use rates were higher in visits to psychiatrists than to other physicians (AOR=5.08; 95% CI, 2.96-8.73), visits covered by public than private insurance (AOR=3.20; 95% CI, 2.25-4.54), visits with diagnosed major depressive disorder than other depressive disorders (AOR= 1.49; 95% CI, 1.08-2.06), and visits with diabetes, hyperlipidemia, or cardiovascular disease (AOR=2.13; 95% CI, 1.12-4.03) and lower in visits by patients >65 years than 18-44 years (AOR=0.51; 95% CI, 0.32-0.82) and visits that included psychotherapy (AOR=0.68; 95% CI, 0.47-0.96). Conclusions: Between 1999 and 2010, SGAs were increasingly accepted in the outpatient treatment of adult nonpsychotic depression.