Researchers have found that many people are receiving anti-depressants to treat conditions that are not related to depression.
While millions of people around the world take anti-depressants to cope with and ease depression, a team from McGill University in Montreal wanted to confirm their suspicions regarding anti-depressants being used as treatment for other illnesses.
Jenna Wong, M.Sc., study author, tells CBS News, “We wanted to see exactly why antidepressants were being prescribed, how often, and for what indications.” There are very little existing studies on the topic.
The study looked at some 10 years of medical records that contain more than 100,000 prescriptions written by some 160 primary care doctors for almost 20,000 patients in Quebec, Canada. The doctors participating in the study wrote down the medications they prescribed, along with at least one indication on why they prescribed such. The researchers included all antidepressants in their examination, except for the older monoamine oxidase inhibitors that are rarely prescribed.
The team found that 55% of all antidepressant prescriptions in the study were given to patients to treat depression. The remaining 45% were prescribed for other conditions such as insomnia, anxiety disorders, pain and panic disorders.
About two-thirds of the prescriptions for conditions aside from depression were given to patients as off-label indications, meaning the drugs were not approved by regulatory agencies to treat that specific condition.
In addition, physicians in the study prescribed anti-depressants for indications that were off-label for all antidepressants, such as migraine, attention-deficit/hyperactivity disorder (ADHD) and digestive system disorders.
These results are concerning, Wong says, because some of the off-label uses may not even be backed by scientific evidence. “I can’t make a statement to say that for sure they don’t work or that they are exposing patients to health risks but there’s the possibility that they could be causing adverse health effects or that they may not be effective for the conditions,” she says. “Without any scientific evidence, it’s hard to be able to say.”
However, Dr. Norman Sussman, Director of the Treatment Resistant Depression Program at NYU Langone Medical Center, says that antidepressants can be used for a wide range of purposes.
“For insomnia use, most knowledgeable internists prescribe many of these medications because they are more effective and less problematic than drugs indicated for insomnia, such as Lunesta and Sonesta, which can have addiction counter-indications,” he says. “For pain, you can go back to medical textbooks from 50 years ago and see that anti-depressants have always been prescribed for certain cases of pain management, like Cymbalta. The reason these drugs do not have FDA recommendation for non-depressive disorders is because securing such indications is costly.”
Sussman is of the opinion that the findings aren’t anything to be worried about. On the contrary, “they validate the fact that primary care doctors are savvy at utilizing these drugs effectively for management of non-depressive disorders,” he explains. “It demonstrates a certain sophistication on the part of practitioners to use these drugs off- label.”
Wong and her team have pressed the theory that some off-label antidepressants prescriptions might be more traditional rather than scientific. That is, “Physicians may be talking to their colleagues and saying, ‘Hey, I’ve used this drug in my patient population and it works,’” Wong says. It then becomes word of mouth. The researchers also point out that marketing and promotions from pharmaceutical companies may factor in this trend.
Both Wong and Sussman agree that more research into off-label uses for anti-depressants is necessary to provide a better insight into the situation. “Hopefully [the study] will increase interest in trying to more carefully study these off-label uses to find out whether we can get any evidence to see if they’re working for these indications,” Wong says.
The study has been published in JAMA.
