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Doctors writing more Rx for mental ills, study says

Doctors prescribed anti-depressants at soaring rates in the 10 years ending in 1994, spurred by the new generation of drugs like Prozac, researchers say.

And stimulant prescriptions took a big jump, with the dramatically increased rate of diagnosing attention deficit hyperactivity disorders in children and adolescents, researchers reported."There has been an enormous increase in research on mental disorders that has elaborated a much better understanding of how they come about and how to treat them more effectively," said Dr. Harold A. Pincus, lead author of a new study in Wednesday's issue of The Journal of the American Medical Association.

"Partly as a byproduct, there's been a large increase in the number of new medications available," he said by telephone Tuesday from Washington, where he is deputy medical director of the American Psychiatric Association.

Also, he said, the stigma of having a mental disorder has waned and people are more willing to seek treatment.

The number of doctor visits in which patients received prescriptions for mental problems rose from 32.7 million to 45.6 million over the decade, the researchers said. That amounted to a 20 percent increase in the share of total doctor visits resulting in prescription of such drugs, called psychotropic drugs, they said.

Visits in which depression was diagnosed almost doubled over the 10 years, from about 11 million to more than 20.4 million, the researchers said.

More growth occurred in the prescribing of anti-depressants than in any other category, from 30.4 percent to 45.2 percent of all psychotropic drugs, the researchers said. At the same time, tranquilizer prescribing fell from 51.7 percent to 33 percent of psychotropic drugs.

Undoubtedly, doctors have switched many patients from tranquilizers, such as Valium, to new anti-depressants such as Prozac because the new drugs work better and more selectively without being habit-forming or causing unpleasant side effects, Pincus said.

While stimulants account for only a small proportion of psychotropic drugs, the rate at which they were prescribed more than tripled in the study, from 1.5 percent to 5.1 percent of all psychotropic drugs given during doctor visits.

"That is almost exclusively aimed toward treatment of children and adolescents with attention deficit hyperactivity disorder," Pincus said.

The study did not explore whether drugs were given appropriately, and Pincus declined to speculate. In recent years, health officials have encouraged more recognition and drug treatment of depression, and campaigns have been waged to increase public and physician awareness of its prevalence.

Dr. Patrick B. Harr, board chairman of the American Academy of Family Physicians, said Prozac was plagued by safety questions - which were debunked by the Food and Drug Administration - in the early 1990s and many patients refused to take it.