Recommending medications for a disease not approved by federal regulators is becoming widespread.

In Quebec, Canada, new research has revealed that nearly half of antidepressant prescriptions were not for depression-related conditions, but for disorders such as anxiety, insomnia and panic attacks.

This off-label prescribing is not illegal, but it's not exactly directly promoted by agencies such as the Food and Drug Administration either.

Because the term "antidepressant" is starting to fall into a misnomer, experts from McGill University in Montreal sought out to investigate how often, why and for what indications antidepressants are being prescribed. The results are published in the journal JAMA.

Examining Prescription Records

Led by Professor Jenna Wong, the McGill researchers looked at a decade of medical records that included 102,000 antidepressant prescriptions written by 158 physicians.

Doctors participating in the study documented drugs they prescribed, as well as the indication or reason for each. All — excluding monoamine oxidase inhibitors — were part of the study.

Wong and her colleagues found that only 55 percent of the antidepressant prescriptions were actually given to patients to treat depression.

The remaining percentages were given to treat other conditions: about 18.5 percent for anxiety disorders, 10 percent for insomnia, 6 percent for chronic pain, and 4 percent for panic disorders.

Researchers also determined that 30 percent of the prescriptions fit the criteria for off-label use. Specifically, two out of three non-depression prescriptions were given under an off-label purpose.

"I wasn't surprised by the indications themselves," said Wong. "But I was surprised by the extent."

Is It Dangerous?

Robyn Tamblyn, senior author of the McGill study, said what they are concerned about is that it is unknown whether off-label drugs used to treat conditions such as migraine are effective.

"These doctors are prescribing in the dark," said Tamblyn.

However, Dr. Peter Kramer, a psychiatrist that specializes in clinical depression, said antidepressants have a wide range of potential uses. He said he has always written that these are not necessarily best called "antidepressants."

These drugs are more active in the nervous system, but whether they actually reverse depression or affect nerve cells in a way that does not target depression is a good question, he said.

Tamblyn said further clinical trials need to be conducted on off-label use for antidepressants to prove or rule out the efficacy of the drug.

In the United States, antidepressant use went up almost 400 percent from 1988 to 1994 and 2005 to 2008. Recent statistics from the Centers for Disease Control and Prevention show that 11 percent of teenagers and adults take antidepressants.

In Australia, antidepressant use has doubled despite years of research suggesting that the medications are not as effective as doctors thought they would be.

Photo: Brandon Giesbrecht | Flickr

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