Off-label antidepressant use is on the rise due to increased prescribing by primary care physicians (PCPs) for nondepressive indications such as insomnia and pain, according to a new study published in JAMA.
Using data from an electronic medical record encompassing 100,000 patients, researchers at McGill University in Montreal, Canada, investigated the antidepressant prescribing patterns of 185 PCPs in community-based primary care practices in Quebec over a ten-year period (January, 2006 to September, 2015). Prescriptions were defined as on-label or off-label based on whether the drug was approved for the indication by Health Canada or the US Food and Drug Administration (FDA) by September 2015. Monoamine oxidase inhibitors were excluded from the analysis.
The researchers found that only 55.2% of the 101,759 antidepressant prescriptions written for 19,734 patients were indicated for depression. The most common off-label uses were for insomnia (10.2%) and pain (6.1%). Other conditions for which off-label antidepressants were prescribed included fibromyalgia, migraine, vasomotor symptoms of menopause, nicotine dependence, premenstrual disorders and syndromes, sexual dysfunction, attention-deficit/hyperactivity disorder, and urinary and digestive system disorders.
During the study period, the percentage of antidepressants prescribed for depression decreased significantly (by 9.73% in serotonin-norepinephrine reuptake inhibitors; 3.95% for selective serotonin reuptake inhibitors; and tricyclic antidepressants by 2.99%). Only mirtazapine prescriptions increased (by 2.36%).
“Between 2006 and 2015, primary care physicians in Quebec commonly and increasingly prescribed antidepressants for nondepressive indications,” the study authors wrote. “When physicians prescribed antidepressants for insomnia and pain, they often prescribed antidepressants of-label.”
They noted that the study was limited by a selective patient population and a small number of prescribers from only one Canadian province. However, they added, “this is the first study to our knowledge to prescribe the prevalence of treatment indications for antidepressants using validated, physician-documented treatment indications recorded at the point of prescribing.”
They added that their study highlighted the need to evaluate the evidence supporting off-label antidepressant use.
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.