Antidepressants: rise in off-label prescriptions
Antidepressant use in North America has increased over the last 2 decades. A suspected reason for this trend is that primary care physicians are increasingly prescribing antidepressants for nondepressive indications, including unapproved (off-label) indications that have not been evaluated by regulatory agencies.
In a study appearing in the May 24 issue of JAMA, Jenna Wong, a Ph.D student in the department of Epidemiology, Biostatistics and Occupational Health, and colleagues analyzed treatment indications for antidepressants and assessed trends in antidepressant prescribing for depression.
The researchers used data from an electronic medical record and prescribing system that has been used by primary care physicians in community-based, fee-for-service practices around 2 major urban centers in Quebec, Canada. The study included prescriptions written for adults between January 2006 and September 2015 for all antidepressants except monoamine oxidase inhibitors. Physicians participating in the study had to document at least 1 treatment indication per prescription using a drop-down menu containing a list of indications or by typing the indication(s).
During the study period, 101,759 antidepressant prescriptions (6 percent of all prescriptions) were written by 158 physicians for 19,734 patients. Only 55 percent of antidepressant prescriptions were indicated for depression. Physicians also prescribed antidepressants for anxiety disorders (18.5 percent), insomnia (10 percent), pain (6 percent) and panic disorders (4 percent). For 29 percent of all antidepressant prescriptions (66 percent of prescriptions not for depression), physicians prescribed a drug for an off-label indication, especially insomnia and pain. Physicians also prescribed antidepressants for several indications that were off-label for all antidepressants, including migraine, vasomotor symptoms of menopause, attention-deficit/hyperactivity disorder, and digestive system disorders.
“The findings indicate that the mere presence of an antidepressant prescription is a poor proxy for depression treatment, and they highlight the need to evaluate the evidence supporting off-label antidepressant use,” the authors write.
The research was supported by the Vanier Canada Graduate Scholarship (Canadian Institutes of Health Research) and the Max E. Binz Fellowship (Faculty of Medicine, McGill University).
Treatment Indications for Antidepressants Prescribed in Primary Care in Quebec, Canada, 2006-2015, Jenna Wong; Aude Motulsky; Tewodros Eguale; David L Buckeridge; Michal Abrahamowicz; and Robyn Tamblyn is published in JAMA