A long-term study of two major urban centers in Quebec, Canada, found that almost half of all antidepressant prescriptions were written for non-depressive indications. The data was collected between January 2006 to September 2015; approximately 185 physicians and 100,000 patients gave informed consent for their information to be used.
Prescription data was retrieved from an electronic medical record (EMR) and prescribing system used by primary care physicians in community-based, fee-for-service practices. Indications were specified by physicians through the EMR via either picking them from a drop-down menu or manually typing them in.
The highest non-depressive indication that antidepressants were prescribed for was anxiety disorders (18.5%), followed by insomnia (10.2%), pain (6.1%), and panic disorders (4.1%). In all, just 55.2% of antidepressant prescriptions were indicated for depression.
Off-label prescriptions – mostly for insomnia and pain – accounted for 29.4% of all prescribed antidepressants. The researchers also noted a gradual decline in the percentage of prescriptions written for depression. A 5-year adjusted risk difference between 2006 and 2015 showed −9.73% (95%CI, −11.86% to −7.61%) for serotonin–norepinephrine reuptake inhibitors, −3.96% (95% CI, −5.33% to −2.59%) for selective serotonin reuptake inhibitors, and −2.99% (95%CI, −4.90% to −1.08%) for tricyclic antidepressants.
The authors acknowledge the limitations presented by having results from only one Canadian province but they also note how theirs is the first study to describe the prevalence of treatment indications for antidepressants using validated indications recorded at the point of prescribing. They conclude by suggesting that the presence of an antidepressant prescription may be a weak indicator of actual depression treatment, exposing a need to further evaluate evidence supporting off-label antidepressant use.
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