Should We Call Them Antidepressants?
Antidepressant use has increased dramatically in the United States, with a 400% increase in utilization since 1990. According to the U.S. Centers for Disease Control and Prevention, approximately 11% of teens and adults currently take antidepressants. While one might conclude that the large numbers of prescriptions written for antidepressants indicates an actual dramatic increase in depressive illness, recent data suggest a more complicated interpretation. Antidepressants are front-line medications for treating depression, but they are also prescribed to treat a wide range of medical problems, including pain, insomnia, and anxiety. This may be particularly true for older adults.
In a recently published study, researchers at McGill University investigated antidepressant prescribing patterns among primary care physicians in Quebec, Canada. They analyzed medical records between 2006 and 2016 across 158 physicians and nearly 20,000 patients. What did they find? Only 55% of antidepressant prescriptions were written specifically for depression. Forty-five percent were written for non-depressive indications and multiple disorders. Approximately 18% were written for anxiety, 10% for insomnia, 6% for chronic pain, and 4% for panic disorders. Other studies reveal that antidepressants are also prescribed for migraines, menopause symptoms, premenstrual syndrome, PTSD, eating disorders, ADHD, and digestive system disorders.
One clear concern with off-label use (applications not approved by a regulating body such as the FDA) of medications is that in many cases, efficacy has not been scientifically established. Certainly, clinical trials establishing the safe and effective use of antidepressants in non-depression disorders are best conducted prior to widespread off-label use, not after it. Yet, healthcare professionals may prescribe off-label antidepressants because they have seen benefits in their patients or have heard of benefits observed by colleagues. A review of the research literature shows that more studies are being conducted investigating the efficacy and safety of off-label use of antidepressants. It is likely that effective treatments for non-depression disorders will be empirically validated. If this does indeed occur, than we might rethink calling these agents “antidepressants.”