Psychiatrists are Significant Prescribers of Sleep Aids, but their Reasons are Different than Primary Care

In August, 2006, the Los Angeles Times carried a story on the increased use of sleep aids and questioned whether direct-to-consumer (DTC) advertising was a key driver behind the increase in use of drug treatment for insomnia.¹ While psychiatrists are the second largest prescribers of sleep aids outside of primary care (family practice, general practice, internal medicine), it is unclear whether DTC advertising has had the same impact on drugs prescribed by this specialty.

Methods

To investigate how psychiatrists use sleep aids relative to primary care physicians, we analyzed data from Verispan's Prescription Drug and Diagnosis Audit (PDDA) database from September, 2005, to August, 2006. PDDA captures data on disease states and associated therapies from 3,100 office-based physicians representing 29 specialties across the United States.

Results

Reasons for use of sleep aids for psychiatrists versus primary care physicians are displayed in Figure 1. As seen in Figure 1, only 11 percent of sleep aid use by psychiatrists is for general symptoms (including insomnia) as compared to 87 percent in primary care physicians. Rather, the majority of use in psychiatry appears to be related to central nervous system (CNS) conditions (e.g., affective psychoses, neurotic disorders, depressive disorders).

Figure 1.

Product Uses by Specialty and Diagnosis, September 2005 to August 2006 (PDDA Class 67290; Specialties- Psych, GP/FM/DO and IM)

Data on use of sleep aids as monotherapy or concomitant with other drugs classes is provided in Figure 2. These data in Figure 2 suggest that the majority of sleep aids (83%) used by psychiatrists are concomitant to a psychiatric medication (e.g., selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, seizure disorder medications, antipsychotics) as opposed to monotherapy whereas the opposite is true in primary care (4% concomitant use vs. 96% monotherapy).

Figure 2.

Product Occurrences by Specialty and Concomitant Class Occurrences (67290; Specialties- Psych, GP/FM/DO and IM)

Conclusion

The data analysis confirms what many physicians may have suspected—there is a difference in how sleep aids are used by psychiatrists and primary care physicians. What many physicians may not have realized, however, is the magnitude of the difference.