One would assume an antidepressant is prescribed for depression, but new research shows almost half are taken for other things. While the study published in the “Journal of the American Medical Association (JAMA)” on Tuesday looked at experience in Canada, the practice of prescribing antidepressants for other causes is widespread in the U.S. too.
The conducted by a McGill University research group found that approximately 45 percent of antidepressants prescribed by primary care physicians (PCP) (as opposed to psychiatrists) in the Quebec area were not intended to for the treatment of depression. They were prescribed for a variety of approved and off-label (not officially approved for that purposes) uses, such as digestive problems and insomnia, migraines, menopausal symptoms like hot flashes, as well as attention deficit and hyperactivity issues.
For the study, the research team analyzed over 100,000 prescriptions for antidepressants for almost 20,000 patients that were written by 158 physicians between January 2006 to September 2015. The doctors were all using an electronic medical records database. Whenever a PCP prescribed a medication from several antidepressant classes, a pop-up appeared and inquired what “indication,” medical jargon for the condition being treated, warranted the prescription.
Reviewing 101,759 prescriptions for antidepressants, the team found that 55 percent cited depressive disorders and 18.5 percent cited anxiety disorders as the indication. Things like insomnia (10 percent), pain (6 percent) panic disorders (4 percent), fibromyalgia, migraines, and obsessive-compulsive disorders were noted on most of the remainder. Small numbers cited sexual dysfunction, nicotine dependence, as well as urinary and digestive system disorders as the reason for the medication. This seems to indicate that depression medication has become a “do something” drug for many doctors to offer patients either if their symptoms only vaguely could be related to depression.
The researchers also indicated that the non-depression usage of the medication grew over time. During the decade of the study, the percentage of antidepressant prescriptions written for depression dropped continuously.
This study does updates older research that showed PCPs routinely prescribing antidepressants without noting any diagnosis at all. Another study found that in a 12-year-period, 56 percent of antidepressant prescriptions written by doctors, other than psychiatrists, did not indicate a formal diagnosis of depression or anxiety issues. The automated pop-up undoubtedly alleviated the problem of missing indications for the new study.
The study did not look at prescriptions written by psychiatrists. They assumed that psychiatrists would not prescribe antidepressants for off-label purposes to the same extent.
“A lot of the off-label use of antidepressants is not evidence-based,” noted Jenna Wong, a PhD student in epidemiology, biostatistics and occupational health, who was the lead author on the study. She noted, as an example, that the antidepressant Trazodone is often prescribed for insomnia in spite of the fact that here is scant evidence that it would benefit the sleep disorder.
Canadians are third among the highest antidepressant users globally, according to a 2013 study. The rate is estimated at 86 doses per 1,000 people. Only Iceland and Australia ranked higher (106 doses and 89 doses per 1,000 people, respectively).
In the U.S. antidepressants are the third-most commonly prescribed medication and now are taken by over 10 percent of adults. That number increased steadily over the past two decades. One theory the researchers espoused as to the increase in the use of antidepressants by PCPs is the increased prescriptions taken for other things than depression.
Written and Edited by Dyanne Weiss
JAMA: Treatment Indications for Antidepressants Prescribed in Primary Care in Quebec, Canada, 2006-2015
TIME: Half of the People Taking Antidepressants Aren’t Depressed: Study
Los Angeles Times: Antidepressants aren’t just for depression anymore, study finds
Medical Daily: 45% Of Depression Meds In Canada Prescribed For Conditions Like Insomnia, Anxiety, And Pain; Is It Really Necessary?
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