According to a clever little paper just out from Italy, prescriptions for antipsychotic drugs skyrocketed in the months following a major earthquake. But there are some surprising details.
On 6th April 2009, an earthquake hit L'Aquila, a medium-sized city in central Italy. Out of about 100,000 people living in the L'Aquila area, over 600 died and over 60,000 were displaced: a major disaster for the local people.
Rossi et al from the University of L'Aquila looked at medication prescription in the 6 months following the earthquake and compared them to the previous 6 months. This is not an ideal method, it would have been better to compare L'Aquila to a neighboring district unaffected by the earthquake to control for nationwide changes; but over a few months we wouldn't expect large changes.
Anyway - they found that the number of "new" antidepressant prescriptions rose by 37%. However, prescriptions of non-psychiatric drugs like statins and anti-diabetic medications also rose by up to 50%. This is a bit sketchy but it suggests that the increase in antidepressants might just reflect increased post-disaster medical care for everyone in the area.
There was one big finding though: rates of antipsychotic prescribing more than doubled to 833 prescriptions, a 130% increase.
Does this mean that more people experienced psychosis in the aftermath of the trauma? That's one possibility - but a closer look reveals that the "extra" antipsychotics were given almost entirely to elderly people: just 0.3% of people under 45 got a new antipsychotic prescription but 1% of those 65-75 did and in those 75+ it reached 2.7% in men and a dizzying 3.8% of women.
Unfortunately Rossi et al couldn't tell what the drugs were being prescribed for, because their dataset was based on drug sales. However, it's known that schizophrenia and other forms of psychosis generally strike younger people, not the elderly. However, antipsychotics are often used as sedatives in elderly people especially those suffering dementia.
As the authors point out, this is a controversial practice:
A further observation concerns the appropriateness of prescribed drugs to a potentially vulnerable group such as the elderly. The majority of prescriptions were made by primary care physicians. This may partly explain the somewhat unusual increase in prescriptions for antipsychotic medications. It has been reported that antipsychotic medications are disproportionately prescribed to elderly subjects and need further regulation. This is particularly true in emergency and disaster situations.
In the UK a 2009 government report warned that antipsychotics were being used too freely in people with dementia, at the risk of causing significant harm, and said that they should be reserved for the most serious cases only. This study raises concerns that already questionable prescribing might get even worse following disasters.
Rossi A, Maggio R, Riccardi I, Allegrini F, & Stratta P (2011). A quantitative analysis of antidepressant and antipsychotic prescriptions following an earthquake in Italy. Journal of traumatic stress, 24 (1), 129-32 PMID: 21351173
