The number of older Americans taking at least three drugs that affect their brains has more than doubled in a decade, according to an analysis published online in February 2017 in JAMA Internal Medicine.
The drugs include antidepressants such as fluoxetine (Prozac), sleep drugs such as zolpidem (Ambien), tranquilizers such as diazepam (Valium), and pain medications such as oxycodone (OxyContin).
What the data showed
Researchers from the University of Michigan and VA Ann Arbor Healthcare System reviewed records from office visits by 97,910 patients 65 and older in the U.S. from 2004 to 2013. The data was collected from a representative sample of doctors' offices by the Centers for Disease Control and Prevention.
During that time, the visits in which three or more brain-affecting, or psychotropic, drugs were started or continued increased from 0.6 percent to 1.4 percent of visits. The authors then applied those percentages to the entire U.S. senior population to estimate that visits involving multiple brain-affecting drugs increased from 1.5 million to 3.68 million.
Rural practices, where access to psychiatric care or pain management is limited, accounted for the largest increase in brain-affecting prescriptions. In nearly half those visits, the patient did not have a mental health or pain diagnosis, leading the authors to conclude that in some cases, those drugs may be overprescribed.
A balancing act
Treating depression, anxiety, insomnia, or pain in older people is a balancing act.
Doctors often prescribe multiple medications to manage those conditions. (The use of multiple medications by a single patient is known as polypharmacy.) But taking the drugs, especially in combination, can be dangerous, increasing the risk of falls, cognitive impairment, drug interactions, and even death in older people.
A patient’s preference for visiting a primary care practice or lack of access to a specialist, such as a psychiatrist, may account for the increase in prescriptions for brain-affecting drugs by primary care doctors. This trend toward overprescription is more rampant in rural areas, where patients lack access to specialized care and turn to primary care doctors for treatment.
Non-drug treatment alternatives—such as psychotherapy, stress management, physical therapy, and professional pain management—were not offered at most visits.
Reduce your risk of bad reactions
If you are taking more than one prescription drug, you can take steps to reduce your risk of dangerous interactions or side effects. The American Geriatrics Society suggests that you:
• Keep a list of your medications, including prescription and over-the-counter drugs and supplements such as vitamins. Show this list to your doctor at every visit so that he or she can prescribe medicine that won't interact with anything you're taking.
• Ask your doctor about the medications you’re taking and what kinds of adverse effects to watch for. Call your doctor immediately if you experience a bad reaction.
• If you’re concerned that a drug you’re taking is either not working or not necessary, talk with your doctor. Do not stop taking the medication without consulting the doctor first.