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Many emergency department visits due to bad psychiatric drug reactions

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According to a new study, almost 90,000 emergency department visits in the US are due to adverse reactions to psychiatric medications. The findings were published on July 9 in the journal JAMA Psychiatry by researchers at the Centers for Disease Control and Prevention (CDC) and Johns Hopkins University.

The authors note that in 2011, an estimated 26.8 million adults in the United States, representing 11.5% of the adult population, took prescription medications to treat mental illness. Psychiatric drugs such as antidepressants, antipsychotics, lithium salts, sedatives, anxiolytics (anxiety-reducing medication), and stimulants, play an important role in the management of mental illness; however, they can also cause significant adverse effects. A wide range of treatments are available for multiple mental illnesses; thus, the authors recommend that healthcare providers should weigh the benefits and risks of psychiatric medications in deciding whether to prescribe one and, if so, which one.

The objective of the study was to estimate the numbers and rates of adverse drug events from psychiatric medications that required emergency department visits among US adults between January 1, 2009, and December 31, 2011. The investigators accessed data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance system and data of drug prescribing during outpatient visits using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey.

The researchers reviewed medical records from emergency department and outpatient visits by adults 19 years or older; the data was subjected to statistical analysis. The following types of drugs were included in the analysis: antidepressants, antipsychotics, lithium salts, sedatives, anxiolytics, and stimulants. They estimated the number of adverse drug events from the aforementioned medications per 10,000 outpatient or emergency department visits.

The investigators found that from 2009 through 2011, an estimated 89,094 emergency department visits for psychiatric medication adverse drug events occurred each year. In addition, 19.3% resulted in hospitalization and 49.4% involved patients aged 19 to 44 years. The numbers of emergency department visits for each type of drug were: sedatives and anxiolytics (30,707), antidepressants (25 377), antipsychotics (21, 578), lithium salts (3,620), and stimulants (2,779). Antipsychotics were implicate in 11.7 visits per 10,000 outpatient prescription visits and lithium salts were implicated in 16.4 visits per 10,000 outpatient prescription visits, compared with 3.6 per 10,000 for sedatives, 2.9 per 100,000 for anxiolytics, and 2.4 per 10,000 for antidepressants. The commonly used sedative zolpidem tartrate was implicated in 11.5% of all adult visits and in 21.0% of visits involving adults 65 years or older; in both these case, the percentages were significantly higher than any other psychiatric medication.

The authors concluded that psychiatric medications cause many adverse drug events that result in a US emergency department visit. They recommended that efforts to reduce adverse drug events should include adults of all ages; however, medications causing high numbers and rates of emergency department visits should be prioritized.