Depression and Anxiety Prescriptions Are Climbing Nationwide

two prescription bottles with pills next to them
Tori Marsh
Tori Marsh, MPH, is on the Research Team at GoodRx, and is the resident expert on drug pricing and savings.
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Prescriptions for depression and anxiety medications are on the rise among Americans – and parts of the country appear to be coping with higher rates than others, according to a GoodRx analysis of prescription data for anxiety and depression medicines.

The data looks at the proportion of depression and anxiety medications among overall prescription volume over the past 12 months (ending April 2018). In most of New England, for instance, these medications account for 10% or higher of all prescriptions, while in California and Hawaii the rate is just 5% of overall prescriptions. Nationwide, an average of around 7% of prescriptions are for anxiety or depression. In much of the country, the proportion of anxiety and depression medications has increased in recent years.

Anxiety and depression are closely related but distinct conditions; people coping with these conditions are often prescribed several medications before finding an effective therapy that helps them. These medications include commonly prescribed drugs like diazepam (brand name Valium) and alprazolam (Xanax) for anxiety and sertraline (Zoloft) and fluoxetine (Prozac).

These numbers are based on a representative sample of US prescription fills (not fills using GoodRx) and comes from several sources including pharmacies and insurers, providing a representative sample of nationwide US prescription drug volume. The four regions are adapted from US Census Bureau definitions.

Of all depression and anxiety medications, sertraline (Zoloft) is the most widely prescribed, accounting for over 1.5% of all prescriptions in some regions. Zoloft is an SSRI (selective serotonin reuptake inhibitor) used to treat depression, anxiety, obsessive-compulsive disorder (OCD), and social anxiety.

Northeast

(Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, New Jersey, Pennsylvania)

Of all regions, fills for anxiety and depression medications are the highest in Northeastern states, accounting for almost 10% of total prescription fills. New Hampshire, Massachusetts, Maine, and Rhode Island fill the highest amount of depression and anxiety medications.

This trend resembles recent data from the CDC  revealing that suicide rates are increasing at an alarming rate especially in Vermont and New Hampshire.

Suicide Rate, 2014-2016 (Per 100,000) (map from NPR)

Data from the Blue Cross Blue Shield Health Index indicates that depression has the highest impact in Northeastern states, specifically Maine, New Hampshire, and Massachusetts. Similarly, a recent piece in The New York Times revealed that google searches for the keyword ‘anxiety’ are highest in northeastern states, specifically in Maine, New Hampshire, Vermont, and Massachusetts.

These statistics may not come as a surprise to many, considering the climates of states in the northeast. Cold gray winters that stretch far into spring have been known to cause ‘seasonal affective disorder,’ also referred to as the ‘winter blues.’ Research has suggested that people with seasonal affective disorder experience higher rates of depression and anxiety during the winters due to a decrease in sunlight. But while seasonal affective disorder accounts for the high rates of depression and anxiety fills in the winter time, it doesn’t quite explain why prescription fills stay high throughout the summer, and continue to increase year over year.

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Midwest

(Illinois, Indiana, Michigan, Ohio, Wisconsin, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota & South Dakota)

Just like the northeast, the Midwest has also seen high fill rates for depression and anxiety medications. In April, fills accounted for 9% of all fills in the midwest, and that number has only continued to increase. According to prescription fills, midwestern states like North Dakota and Iowa cope with the highest rates of anxiety in depression. What’s more, compared to all regions, the Midwest has seen the highest increase of fills for depression and anxiety medications; in just four years, fills increased by 17%.

This data aligns closely with CDC data indicating that people Ohio, Indiana, and Kentucky experienced a higher number of mentally unhealthy days characterized by feelings of stress or depression.

Mean number of mentally unhealthy days during a 30-day period

Just like the Northeast, seasonal affective disorder could be leading to higher rates of anxiety and depression. But why do fills remain high throughout the summer?

South

(Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia, Alabama, Kentucky, Mississippi, Tennessee, Arkansas, Louisiana, Oklahoma & Texas)

In the south, fills for depression and anxiety medications accounted for 8% of all prescription fills, a rate that has been steadily increasing since 2016. Alabama, Kentucky, and West Virginia saw the highest fill rates, while fills for anxiety and depression medications accounted for only 6% in Georgia.

These results are supported by research done by the American Psychological Association that surveyed self-reported anxiety levels in 1,226 American adults. According to the research, 32% of participants indicated that their stress levels had decreased over the past year, a rate that surpassed other regions by as much as 11%. The survey also found that people in the south understood the impacts of stress and how to manage their stress more than participants in other regions.

West

(Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming, Alaska, California, Hawaii, Oregon & Washington)

States in the west fill the fewest amount of depression and anxiety medications, about 6% of total prescriptions to be exact. Unlike the other three regions, where fills have been steadily increasing, prescriptions for depression and anxiety medications have remained relatively consistent in the west coast, hovering around 6% over the past four years. Of all states on the west coast, Montana fills the highest amount of prescriptions for depression and anxiety. Not surprisingly, Hawaii seems to be a relatively happy state, as only 4% of prescription fills are for anxiety and depression medications.

It’s clear that those on the west coast are feeling less depressed and stressed. According to the American Psychological Association, westerners are highly satisfied with their overall health, believe they manage their stress well, and participate in stress-relieving activities like physical exercise.

If you or someone you know is struggling with depression or has had thoughts of harming themselves or taking their own life, get help. The National Suicide Prevention Lifeline (1-800-273-8255) provides 24/7, free, confidential support for people in distress, as well as best practices for professionals and resources to aid in prevention and crisis situations.

Drugs included in this analysis:

Anxiety only drugs: alprazolam, alprazolam er, Ativan, buspirone, chlordiazepoxide, clorazepate, diazepam, Effexor XR, lorazepam, meprobamate, perphenazine/amitriptyline, Tranxene, Valium, Xanax

Depression only drugs: bupropion, bupropion sr, Celexa, chlordiazepoxide/amitriptyline, citalopram, desvenlafaxine er, desvenlafaxine succinate er,doxepinEffexor cr, Fetzima, fluoxetine, Khedezla, Pexeva, Pristiq, Prozac, venlafaxine, Viibryd, Wellbutrin, Wellbutrin SR, Wellbutrin XL

Overlapping drugs: Cymbalta, duloxetine, escitalopram, Lexapro, paroxetine, paroxetine er, Paxil, Paxil cr, sertraline, venlafaxine er, Zoloft

Drugs featured in this story

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