OBJECTIVES: Prescribing psychotropic medications without a psychiatric diagnosis may pose inappropriate use, misuse, or a risk of developing significant adverse drug events. This study estimates prevalence and national trends of initiation of psychotropic medications without a psychiatric diagnosis, and identify correlates independently associated with such use among US adults in outpatient visits.

METHODS: Data were gathered from the 2006-2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based U.S. outpatient care. The sample was limited to adults aged 18 or older who received a new psychotropic drug prescription (n=9,426 unweighted). Psychotropic prescriptions were classified into one of five groups using generic names (antipsychotics, antidepressants, anxiolytics, sleep-specific anxiolytics, or others). Using a repeated cross-sectional design with survey sampling techniques, we estimated prevalence rates and national trends. Multivariable-adjusted logistic regression analysis was used to identify demographic and clinical correlates independently associated with initiation of psychotropic prescriptions without a psychiatric diagnosis.

RESULTS: Altogether, at 62.1% of visits at which a psychotropic prescription was initiated, no psychiatric diagnosis was recorded for the visit. Overall, the rate increased from 61% in 2006-2007 to 69.5% in 2008-2009, and then decreased to 53.3% in 2014-2015. Visits to psychiatrists were associated with very low odds of having no psychiatric diagnosis when compared to primary care visits (OR=0.02; 95% CI, 0.01-0.04). Visits to non-psychiatric specialists showed 6.89 times greater odds of not having a psychiatric diagnosis when compared to primary care visits (95% CI, 5.34-8.82). Among psychotropic drug classes, sleep-specific anxiolytics was associated with 3.29 times greater odds of not having a psychiatric diagnosis, when compared to antipsychotic prescriptions (95% CI, 2.03-5.34).

CONCLUSIONS: Psychotropic medications are commonly initiated without any psychiatric diagnosis, especially among non-psychiatrist physicians. Non-psychiatrists should document relevant diagnoses more vigilantly to prevent potentially inappropriate use or misuse.