June 7, 2016
Nearly half of people taking depressants are not suffering from depression at all, according to a study conducted by researchers from McGill University in Montreal, and published in the Journal of the American Medical Association (JAMA).
These people have been prescribed the drugs for “off label” uses not approved by drug regulatory agencies. These uses have never been proven safe or effective.
“It’s an interesting phenomenon,” author Jenna Wong said. “We had heard that in the scientific community there has been a suspicion among doctors that physicians are commonly prescribing antidepressants for uses other than depression. We also found that for the major classes of antidepressants, there was an increasing prescribing trend over time.”
Treatments not backed by evidence
The researchers reviewed 10 years of antidepressant prescription records, containing data on more than 100,000 prescriptions written by approximately 160 doctors for nearly 20,000 patients. They analyzed trends of prescribing for every antidepressant class except monoamine oxidase inhibitors, which are almost never prescribed as antidepressants anymore and therefore rarely occurred in the records.
They found that only 55 percent of the prescriptions were written for depression. The other 45 percent were written for anxiety (18.5 percent), insomnia (10 percent), pain (6 percent), panic disorders (4 percent), and for a slew of conditions that are off-label for every antidepressant, including attention deficit hyperactivity disorder (ADHD), digestive disorders, eating disorders, migraine and vasomotor menopause symptoms.
Twenty-nine percent of antidepressant prescriptions were written for a use that was off-label for that particular drug. Fully 66 percent of prescriptions written for conditions other than depression were off label.
If nothing else, the study shows that rates of antidepressant prescriptions are a not a good indicator of the rate at which depression is being diagnosed, or treated, the authors noted. It also raises concerns that the drugs are being so widely used for conditions not backed by scientific research.
“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 wrote.
Wong noted that off-label uses have never been proven effective, and may also carry a risk of unknown side effects.
“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,” Wong said. “Without any scientific evidence, it’s hard to be able to say.”
“It raises the question of why they are prescribing them,” she said.
The authors speculated that many doctors are relying on tradition or informal channels of information, rather than scientific research.
“Physicians may be talking to their colleagues and saying, ‘Hey, I’ve used this drug in my patient population and it works,'” Wong said. “So it’s more word of mouth.”
Other potential reasons for off-label prescribing may be marketing by pharmaceutical companies or simply the use of antidepressants as a last resort when other treatments have failed.
“Some of these conditions are things where there is no exact treatment,” Wong said. “The patients may be desperate for something to treat their ailments.”
The findings are particularly troubling given how many studies have shown that antidepressants have little, if any, benefit over a placebo – but with a much higher rate of potentially dangerous side effects, including suicide.
In an article published last year in the British Medical Journal, esteemed evidence-based medicine researcher Peter Gotzsche argued that nearly all psychiatric drugs, including antidepressants, could be discontinued without harming public health. In fact, he said, there would probably be a benefit; currently, these drugs kill 500,000 people per year – and that’s just for people over the age of 65 living in Western countries.