Antidepressant use in North America has jumped in the last two decades, perhaps because doctors are increasingly prescribing them for conditions other than depression, like anxiety, pain, and insomnia.
For a new study, Jenna Wong, a PhD student in the epidemiology, biostatistics, and occupational health department at McGill University, used data from an electronic medical record and prescribing system that has been used by primary care physicians in community-based, fee-for-service practices around two major urban centers in Quebec, Canada.
The study includes prescriptions written for adults between January 2006 and September 2015 for all antidepressants except monoamine oxidase inhibitors. Physicians participating in the study had to document at least one treatment indication per prescription using a drop-down menu containing a list of indications or by typing the indication(s).
During the study period, 101,759 antidepressant prescriptions (6 percent of all prescriptions) were written by 158 physicians for 19,734 patients. But, only 55 percent of those were written for depression.
They were also prescribed for anxiety disorders (18.5 percent), insomnia (10 percent), pain (6 percent), and panic disorders (4 percent). In addition, for 29 percent of all antidepressant prescriptions (66 percent of prescriptions not for depression), doctors prescribed a drug for an off-label indication, especially insomnia and pain.
Doctors also prescribed antidepressants for several indications that were off-label for all antidepressants, including migraine, menopause, attention-deficit/hyperactivity disorder, and digestive system disorders.
“The findings indicate that the mere presence of an antidepressant prescription is a poor proxy for depression treatment, and they highlight the need to evaluate the evidence supporting off-label antidepressant use,” the authors write in the Journal of the American Medical Association.
The Vanier Canada Graduate Scholarship (Canadian Institutes of Health Research) and the Max E. Binz Fellowship (Faculty of Medicine, McGill University) sponsored the work.
Source: McGill University