A new study from the University of McGill in Montreal, Quebec, finds that almost half of all antidepressants prescribed by primary care doctors in the province are not being taken for depression, a result which raises concerns about the “off-label” use of antidepressants.
The study looked at prescription records from 185 physicians based around two major urban centres in Quebec and found that of 101,759 antidepressant prescriptions made for 19,734 patients between January 1, 2006, and September 30, 2015, only 55.2 per cent were intended to treat depression. 18.5 per cent of prescriptions were intended to treat anxiety disorders, 10.2 per cent for insomnia, 6.1 per cent for pain and 4.1 per cent for panic disorders. Other uses observed to a lesser extent included treatment of migraine, symptoms of menopause, attention-deficit hyperactivity disorder and digestive system disorders. Researchers noted that the rate of prescription for purposes other than depression had increased significantly between 2006 and 2015.
“This is the first study to our knowledge to describe the prevalence of treatment indications for antidepressants using validated, physician-documented treatment indications recorded at the point of prescribing,” say the study’s authors.
And while some types of off-label use such as prescribing the antidepressant amitriptyline to treat the symptoms of migraine have scientific evidence to back up the practice, many others do not, a cause for concern amongst physicians and health advocates.
“Unless there is pretty good evidence that the off-label use is actually beneficial – and by pretty good I mean evidence that isn’t generated by the drug companies themselves – I wouldn’t use it unless it was a last resort,” says Dr. Joel Lexchin, emergency room physician and drug policy expert at York University in Toronto.
Since the approval of Prozac (fluoxetine) in 1987 by the United States Food and Drug Administration, antidepressant use has steadily grown in popularity, quadrupling in the U.S. with more than one in ten Americans now taking antidepressants, making antidepressants the second most commonly prescribed drug after cholesterol-lowering drugs. In Canada, per capita antidepressant usage ranks third among all nations, bested only by Iceland and Australia.
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Along with off-label usage, prescription without proper diagnosis is considered a problem endemic to medical practice. A 2011 study from the Johns Hopkins University Bloomberg School of Public Health found that 56 per cent of antidepressant prescriptions written by physicians who were not psychiatrists were given without a formal diagnosis of depression or anxiety disorder.
“To the extent that antidepressants are being prescribed for uses not supported by clinical evidence, there may be a need to improve providers’ prescribing practices, revamp drug formularies or undertake broad reforms of the health care system that will increase communication between primary care providers and mental health specialists,” said lead author of the study, Dr. Ramin Mojtabai of the Bloomberg School’s Department of Mental Health.
The McGill University study is published in JAMA – the Journal of the American Medical Association.