Antidepressants regularly prescribed for off-label indications
Antidepressant use for anxiety, panic, and ADHD has increased.
Primary care clinicians are regularly prescribing antidepressants to patients for nondepressive indications, according to research published in JAMA.
Jenna Wong, MSc, of McGill University in Montreal, and colleagues conducted an analysis of data collected from an electronic medical record and prescribing system. All antidepressant prescriptions written for adults between January 2006 and September 2015 at 2 major urban centers in Quebec, Canada, were included; at least one treatment indication had been documented per prescription.
During the study period, 101,759 antidepressant prescriptions were written by 158 clinicians for 19,734 patients; 55% of these prescriptions were indicated for depression. Antidepressants were also prescribed for anxiety disorders (18.5%), insomnia (10%), pain (6%), and panic disorders (4%). The most frequently prescribed antidepressants for these indications were citalopram (29.5% of prescriptions for the indication), trazodone (76.6%), amitriptyline (65.1%), and paroxetine (35.9%). Clinicians also prescribed antidepressants for migraines, vasomotor symptoms of menopause, ADHD, and digestive system disorders. For 29% of all antidepressant prescriptions – 66% of prescriptions not for depression – clinicians prescribed a drug for an off-label indication.
“Antidepressant use in the United States has increased over the last 2 decades,” said Ms Wong. “A suspected reason for this trend is that primary care physicians are increasingly prescribing antidepressants for nondepressive indications, including unapproved (off-label) indications.”
“The findings indicate that the mere presence of an antidepressant prescription is a poor proxy for depression treatment,” Ms Wong concluded.
- Wong J, Motulsky A, Eguale T, et al. Treatment indications for antidepressants prescribed in primary care in Quebec, Canada 2006-2015. JAMA. 2016;315(20):2230-2232; doi: 10.1001/jama.2016.3445