February 23, 2019
A lot of prescription bottles pilled up.

Are You Taking Too Many Brain-Affecting Drugs?

by Health After 50

Treating depression, anxiety, insomnia, or pain is a balancing act. Doctors often prescribe multiple medications to manage those conditions. But taking the drugs, especially in combination, can be danger­ous for older adults because they increase the risk of falls, cognitive impairment, drug interactions, and even death.

Despite these risks, the number of older Americans taking at least three drugs that affect the brain has more than doubled in a decade, according to an analysis published online in 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 show

Researchers from the University of Michigan and VA Ann Arbor Healthcare System reviewed records from office vis­its of 97,910 patients ages 65 and older from 2004 to 2013. The data were col­lected from a representative sample of doctors’ offices by the CDC.

During that time, the doctor visits in which three or more brain-affecting, or psychotropic, drugs were started or con­tinued increased from 0.6 to 1.4 percent of visits. The researchers 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. (The use of multiple medications by a single patient is known as polypharmacy.)

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 those drugs may sometimes be overprescribed.

Reduce Your Risk of Bad Drug Reactions

If you’re taking more than one pre­scription drug, you can take steps to reduce your risk of dangerous inter­actions or side effects. Here are suggestions from the American Geriatrics Society.

Why brain-affecting prescriptions are increasing

Sometimes, patients may prefer to visit a primary care practice instead of a mental health professional, or they may not have access to specialists like psychiatrists. Also, efforts have been made to encour­age primary care doctors to treat more mental disorders, given how common such illnesses are. Those reasons may help account for the increase in prescrip­tions for brain-affecting drugs by primary care doctors.

In their review, the researchers found that in rural areas (where there is less access to nondrug alternatives), doctors didn’t offer treatments such as psycho­therapy, stress management, physical therapy, and professional pain manage­ment at most visits. This may explain, in part, why people living in rural areas are more likely to be prescribed multiple brain-affecting medications.

The analysis revealed that polyphar­macy significantly increased for individu­als who had a pain diagnosis, which was attributed to the overall growth in the prescribing of opioids. Many people turn to prescription opioids—pain relievers such as oxycodone, acetaminophen/hydrocodone (Vicodin), and acetamino­phen/oxycodone (Percocet)—to treat chronic pain. Over time, opioid use can lead to physical dependency and with­drawal symptoms. Little high-quality evidence is available that supports the long-term use of opioids for chronic non­cancer pain. Yet, more than 16,000 peo­ple die from prescription pain reliever overdoses each year, according to the CDC. Unfortunately, little research exists for alternatives, which has led to an over­reliance on opioids.

This article first appeared in the May 2018 issue of UC Berkeley Health After 50.

Also see The Risks of Anti-Anxiety Pills.