NDLI: Off-Label Prescribing of Psychotropic Medication, 2005-2013: An Examination of Potential Influences.

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Off-Label Prescribing of Psychotropic Medication, 2005-2013: An Examination of Potential Influences.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	O'Brien, Peggy L. Cummings, Nicholas Mark, Tami L.
Description	Author Affiliation: O'Brien PL ( Dr. O'Brien is with Truven Health Analytics, L.L.C., Cambridge, Massachusetts (e-mail: marbrien@us.ibm.com ). Mr. Cummings and Dr. Mark are with the Truven Health Analytics, L.L.C., office in Bethesda, Maryland.); Cummings N ( Dr. O'Brien is with Truven Health Analytics, L.L.C., Cambridge, Massachusetts (e-mail: marbrien@us.ibm.com ). Mr. Cummings and Dr. Mark are with the Truven Health Analytics, L.L.C., office in Bethesda, Maryland.); Mark TL ( Dr. O'Brien is with Truven Health Analytics, L.L.C., Cambridge, Massachusetts (e-mail: marbrien@us.ibm.com ). Mr. Cummings and Dr. Mark are with the Truven Health Analytics, L.L.C., office in Bethesda, Maryland.)
Abstract	OBJECTIVE: This study examined rates of psychotropic prescriptions for various on- and off-label uses in 2005 and 2013 in the context of changes in labeled indications. METHODS: The National Disease and Therapeutic Index, a survey of nationally representative office-based physicians that identifies the diagnosis attached to each prescription, was used to capture the number of psychiatric medications prescribed for a particular diagnosis in 2005 (N=4,120) and 2013 (N=4,140). Labeled indications for each year were abstracted, and the association of prescribing patterns and changes in labeled indications was evaluated. RESULTS: Expanded labeling was associated with increased use of antidepressants for anxiety (an increase of 3.4 percentage points); antipsychotics for depression (8.3), bipolar disorder (3.4), and tic disorders, autism, and related disorders (1.5); and anxiolytics for anxiety disorders (5.5). Use of antidepressants for depression decreased, by 5.6 percentage points, as did use of antipsychotics (4.6) and anxiolytics (.7) for dementia-related disorders and of antipsychotics for attention-deficit and related disorders (2.7), likely reflecting black box warnings and evidence of side effects. Off-label use of antidepressants for attention deficit and related disorders and anxiolytics for bipolar disorders increased by 1.1 and 1.3 percentage points, respectively. CONCLUSIONS: FDA labeling plays an important but imperfect role in influencing how providers select medications. Prescribing increases for medications with new indications. Conversely, black box warnings of potentially dangerous side effects result in decreased prescribing. However, labeled indications often lag the science, and prescribing patterns should be tracked to inform the need for more education, research, and labeling changes.
File Format	HTM / HTML
ISSN	10752730
e-ISSN	15579700
Journal	Psychiatric Services
Language	English
Publisher	American Psychiatric Association
Publisher Date	2017-01-17
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Psychiatry
Content Type	Text
Resource Type	Article
Subject	Psychiatry and Mental Health

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