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ANN ARBOR, MI - The number of older Americans who take three or more medicines that affect their brains has more than doubled in just a decade, a new study finds. The sharpest rise occurred in seniors living in rural areas, where the rate of doctor visits by seniors taking combinations of such drugs - opioids, antidepressants, tranquilizers and antipsychotics - more than tripled. This "polypharmacy" of drugs that act on the central nervous system is concerning, the researchers say, because of the special risks to older adults that come with combining multiple such medications. Falls - and the injuries that can result from them - are the chief concern, along with problems with driving, memory and thinking. Combining opioid painkillers with certain other brain-affecting drugs such as benzodiazepine tranquilizers is of particular concern, recently receiving the strongest possible warning from the U.S. Food and Drug Administration due to an increased risk of death from combined use. Publishing in JAMA Internal Medicine, (link is external)the team from the University of Michigan and VA Ann Arbor Healthcare System reports findings from their analysis of data collected from a representative sample of doctors' offices between 2004 and 2013 by the Centers for Disease Control and Prevention. While only 0.6 percent of doctor visits by people over the age of 65 involved three or more CNS-affecting drugs in 2004, the number had risen to 1.4 percent in 2013. If that percentage is applied to the entire U.S. senior population, that means 3.68 million doctor visits a year involve seniors taking three or more CNS drugs. "The rise we saw in these data may reflect the increased willingness of seniors to seek help and accept medication for mental health conditions - but it's also concerning because of the risks of combining these medications," says Donovan Maust, M.D., M.S., the study's lead author and a geriatric psychiatrist at Michigan Medicine, the U-M academic medical center. [caption id="attachment_2408" align="alignright" width="125"]paper published online-first in Psychiatric Services(link is external) in January, they report that more than half of 231 older patients who had been prescribed an antidepressant for depression by their primary care doctor for depression (as opposed to off-label use for sleep, for example) did not actually meet the criteria for Major Depressive Disorder. The patients were participating in a randomized controlled trial aimed at improving depression outcomes and are not considered a representative sample of older Americans, but Maust and his colleagues note that their findings could indicate an over-prescribing trend. Maust and his colleague Helen Kales, M.D. also wrote an invited commentary in JAMA Internal Medicine(link is external) in January, about the use of CNS drugs to "medicate distress' in older people. In addition to Maust and Kales, the authors of the JAMA Internal Medicine research letter are Lauren B. Gerlach, D.O., Anastasia Gibson, and Frederic Blow, Ph.D. of U-M, and Mark Olfson, M.D., M.P.H. of Columbia University and the New York State Psychiatric Institute. Ilse Wiechers, M.D., M.P.P., M.H.S., of Yale University co-authored the benzodiazepine study. Maust, Kales and Blow are members of the U-M Institute for Healthcare Policy and Innovation and the VA Center for Clinical Management Research. Blow is the director of the U-M Addiction Center and Kales directs the Program for Positive Aging. The study was supported by a National Institute on Aging Beeson Career Development Award (NIA K08AG048321, AFAR, The John A. Hartford Foundation, and The Atlantic Philanthropies) Reference: JAMA Internal Medicine, doi:10.1001/jamainternmed.2016.9225