Disparities in Antidepressant Use: In Reply

In Reply: We are happy to see that our article has received attention from clinical researchers like Dr. Cooke. Our primary intention was to provide a descriptive study on racial-ethnic disparities in antidepressant use among patients with private insurance coverage, so that other researchers would be aware of the issue and would conduct further studies on this topic with more nuanced perspectives. We appreciate Dr. Cooke’s thoughtful comments, which are the kind of reactions we hoped to get.

We agree with Dr. Cooke—and with the authors whose studies she cites—that the type of care provider (primary care versus specialty care) is an important factor in antidepressant prescribing. Disparities in use of specialty care, combined with the differential prescribing rates of primary and specialty care providers that have been shown in other studies, may have further implications for disparities in antidepressant use. We did not examine type of care provider in our study for two main reasons. First, exploring potential mechanisms behind the disparities was beyond the scope and the original intention of our study. Second, the data from the Medical Expenditure Panel Surveys (MEPS) used in the study, specifically the “Prescribed Medicines” and the “Medical Conditions” files, do not provide information on prescribers.

Given the potential importance of this additional layer of disparity, future research may explore the MEPS “Outpatient Visits” files and “Office-Based Medical Provider Visits” files to identify the type of physician that prescribed the antidepressant. This perspective can be particularly relevant when evaluating coverage expansion under the Affordable Care Act. The potential change in the pattern of specialty care utilization across different racial and ethnic groups under the coverage expansion is itself an interesting research topic.