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Older vets commonly prescribed psychiatric drugs without diagnosis

Older veterans are often prescribed psychotropic medications without receiving a psychiatric diagnosis, according to recent study findings published in The American Journal of Geriatric Psychiatry.

Ilse R. Wiechers, MD, MPP, of Yale School of Medicine and the US Department of Veterans Affairs, and colleagues evaluated national Veterans Health Administration data from fiscal year 2010 to determine the rates of veterans being prescribed psychotropic medications without a psychiatric diagnosis.

Ilse R. Wiechers

Thirty-three percent of all veterans (n=1.85 million) filled a prescription for a psychotropic medication. Of those, 53% utilized mental health care. Ninety-eight percent of mental health utilizers had a psychiatric diagnosis vs. 39% of non-mental health utilizers.

Seventy-two percent of veterans filling psychotropic prescriptions were prescribed antidepressants, followed by 40% benzodiazepine/sedatives/hypnotics, 30% anticonvulsant mood stabilizers and 18% antipsychotics.

Overall, a same-year diagnosis of a psychiatric disorder was not present in 30% of participants who filled any psychotropic prescription.

Even when considering potential use for medical illnesses, psychotropic medications were more likely to be prescribed without a psychiatric diagnosis to older veterans.

“In conclusion, large numbers of outpatient veterans, especially those over age 65 and those not seen in specialized psychiatric clinics, are prescribed psychotropic medications without either a psychiatric diagnosis or other documented medical indications for such use,” the researchers wrote. “This practice may represent exposure of vulnerable older patients to side effects of psychotropic medications without clear clinical indications for use, underdiagnosis of mental illness, or incomplete documentation. Further understanding of this phenomenon and initiatives for its remediation deserve consideration.”

Ilse R. Wiechers, MD, MPP, can be reached at ilse.wiechers@yale.edu.

Disclosure: See the study for a full list of researchers’ financial disclosures.