Antidepressants not for depression

Canadian doctors increasingly issuing prescriptions for different conditions, even without scientific evidence

When is an antidepressant not an antidepressant? It sounds like the opening to a joke, but in fact new research suggests that in one Canadian province antidepressants are being used for many other things than the condition they are meant for.

According to a study from researchers at McGill University, primary care doctors in Quebec are prescribing the pills for different conditions, including sexual dysfunction, despite the fact that there is little scientific evidence to back up their use in these directions.

In fact, close to half of the anti-depressants prescribed in the province are not intended to treat depression, according to the study. For example, Trazodone is often being prescribed for insomnia. Overall, 55 per cent are actually written for depression; 18.5 per cent for anxiety disorders; 10 per cent for insomnia; six per cent for pain and four per cent for panic disorders. Other off-label prescriptions for which the drugs are used include migraines and urinary disorders.

Speaking to the Montreal Gazette, Jenna Wong, the leading author of the study commented that “a lot of the off-label use of antidepressants is not evidence-based.”

However, not all alternative uses of the drugs are without research – for example, amitriptyline has been proven for use in treating neuropathic pain.

Speaking to the Montreal publication, Dr Joel Lexchin, a drug policy expert with York University, commented that the study offers important lessons to physicians and that without “pretty good evidence” he would not prescribe the drugs “unless it was a last resort”.