Skip to main content
×
×
Home

Off-label prescribing in people with recurrent depressive disorder attending a community mental health service

  • Chinedu E. Uzoechina, Pieter Hilvering, Cathryn Rogers, Sinead O'Brien, Ananth Pullela, Mushtaq Yousafzai (a1) and David J. Meagher (a1) (a2)...
Abstract
Aims and method

We investigated deliberate and inadvertent off-label prescribing in individuals with recurrent depressive disorder attending a community mental health service.

Results

Off-label prescribing occurred in 87 of 226 people with recurrent depressive disorder (38%) and involved antipsychotic agents (41), maintenance benzodiazepine use (33), antidepressant polypharmacy (28), high-dose antidepressants (19) and use of antidepressants outside of the recommended age range (16). Off-label prescribing was part of a deliberate and documented treatment plan for a half (n = 43) of individuals. Participants receiving off-label prescribing had higher total Health of the Nation Outcome Scale (HoNOS) scores, were attending more frequently and were older and had more chronic illness duration. Inadvertent off-label prescribing was related to higher scores on the behavioural disturbance subscale of the HoNOS.

Clinical implications

Off-label prescribing is a common phenomenon in people with recurrent depressive disorder and relates to greater illness severity and chronicity. Although off-label prescribing is frequently deliberate, in many cases it is undesirable and unplanned.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Off-label prescribing in people with recurrent depressive disorder attending a community mental health service
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Off-label prescribing in people with recurrent depressive disorder attending a community mental health service
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Off-label prescribing in people with recurrent depressive disorder attending a community mental health service
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
David Meagher (David.Meagher@ul.ie)
Footnotes
Hide All

Declaration of interest

Unrelated to this research, D.J.M. has received research grant funding from AstraZeneca Pharmaceuticals.

Footnotes
References
Hide All
1 Radley, DC, Finkelstein, SN, Stafford, RS. Off-label prescribing among office-based physicians. Arch Intern Med 2006; 166: 1021–6.
2 Royal College of Psychiatrists. Use of Licensed Medicines for Unlicensed Applications in Psychiatric Practice (College Report CR142). Royal College of Psychiatrists, 2007.
3 Harrington, M, Lelliot, P, Paton, C, Okocha, C, Duffett, R, Sensky, T. The results of a multi-centre audit of the prescribing of antipsychotic drugs for in-patients in the UK. Psychiatr Bull 2002; 26: 414–8.
4 Hodgson, R, Belgamwar, R. Off-label prescribing by psychiatrists. Psychiatr Bull 2006; 30: 55–7.
5 Baldwin, DS, Kosky, N. Off-label prescribing in psychiatric practice. Adv Psychiatr Treat 2007; 13: 414–22.
6 Taylor, D, Paton, C, Kerwin, R. Maudsley Prescribing Guidelines, 9th edn. Informa Healthcare, 2007.
7 Stafford, RS. Regulating off-label drug use – rethinking the role of the FDA. N Engl J Med 2008; 358: 1427–9.
8 Jonville-Béra, AP, Béra, F, Autret-Leca, E. Are incorrectly used drugs more frequently involved in adverse drug reactions? A prospective study. Eur J Clin Pharmacol 2005; 61: 231–6.
9 World Health Organization. The ICD–10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
10 Meagher, D, O'Brien, S, Pullela, A, Oshun, A, Brosnan, P. Multidisciplinary activities in a community mental health service: relationship to Health of the Nation Outcome Scale scores and diagnosis. Psychiatr Bull 2009; 33: 172–5.
11 Wing, JK, Beevor, AS, Curtis, RH, Park, SB, Hadden, S, Burns, A. Health of the Nation Outcome Scales (HoNOS). Research and development. Br J Psychiatry 1998; 172: 11–8.
12 Bebbington, P, Brugha, T, Hill, T, Marsden, L, Window, S. Validation of the Health of the Nation Outcome Scales. Br J Psychiatry 1999; 174: 389–94.
13 British Medical Association, Royal Pharmaceutical Society of Great Britain. British National Formulary, 58th edn. BMJ Books, Pharmaceutical Press, 2009.
14 Douglas-Hall, P, Fuller, A, Gill-Banham, S. An analysis of off-licence prescribing in psychiatric medicine. Pharm J 2001; 267: 890–1.
15 Barbui, C, Ciuna, A, Nosé, M, Patten, SB, Stegagno, M, Burti, L, et al. Off-label and non-classical prescriptions of antipsychotic agents in ordinary in-patient practice. Acta Psychiatr Scand 2004; 109: 275–8.
16 Weiss, E, Hummer, M, Koller, D, Ulmer, H, Fleischhacker, WW. Off-label use of antipsychotic drugs. J Clin Psychopharmacol 2000; 20: 695–8.
17 Rosenheck, R, Leslie, D, Sernyak, M. From clinical trials to real-world practice: use of atypical antipsychotic medication nationally in the Department of Veteran Affairs. Med Care 2001; 39: 302–8.
18 Leslie, DL, Mohamed, S, Rosenheck, RA. Off-label use of antipsychotic medications in the Department of Veteran Affairs health care system. Psychiatr Serv 2009; 60: 1175–81.
19 Chen, H, Reeves, JH, Fincham, JE, Kennedy, WK, Dorfman, JH, Martin, BC. Off-label use of antidepressant, anticonvulsant, and antipsychotic medications among Georgia medicaid enrollees in 2001. J Clin Psychiatry 2006; 67: 972–82.
20 Kamble, P, Sherer, J, Chen, H, Aparasu, R. Off-label use of second generation antipsychotic agents among elderly nursing home residents. Psychiatr Serv 2010; 61: 130–6.
21 Mojtabai, R, Olfson, M. National trends in psychotropic medication polypharmacy in office-based psychiatry. Arch Gen Psychiatry 2010; 67: 2636.
22 Lowe-Ponsford, F, Baldwin, D. Off-label prescribing by psychiatrists. Psychiatr Bull 2000; 24: 415–7.
23 Nelson, JC, Papakostas, GI. Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomised trials. Am J Psychiatry 2009; 166: 980–91.
24 Meagher, D, Hannan, N, Leonard, M. Duloxetine-mirtazapine combination in depressive illness: the case for Limerick ‘rocket fuel’. Irish J Psychol Med 2006; 23: 116–8.
25 Hannan, N, Hamzah, Z, Akinpeloye, HO, Meagher, D. Venlafaxinemirtazapine combination in the treatment of persistent depressive illness. J Psychopharmacol 2007; 21: 161–4.
26 Thase, ME, Shelton, RC, Khan, A. Treatment with venlafaxine extended release after SSRI nonresponse or intolerance: a randomized comparison of standard- and higher-dosing strategies. J Clin Psychopharmacol 2006; 26: 250–8.
27 Raju, B, Meagher, D. Patient-controlled benzodiazepine dose reduction in a community mental health service. Irish J Psychol Med 2005; 22: 42–5.
28 Moran, M, Raju, B, Saunders, J, Meagher, D. Achieving evidence-based prescribing practice in an adult community mental health service. Psychiatr Bull 2006; 30: 51–5.
29 Meagher, D, Pullela, A, Meisinger, M, Geaney, N, O'Brien, S. Five-year follow up of an evidence-based prescribing intervention. Psychiatr Bull 2008; 32: 183–6.
30 Haw, C, Stubbs, J. Benzodiazepines: a necessary evil? A survey of prescribing at a specialist UK psychiatric hospital. J Psychopharmacol 2007; 21: 645–9.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 31 *
Loading metrics...

Abstract views

Total abstract views: 37 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 23rd July 2018. This data will be updated every 24 hours.

Off-label prescribing in people with recurrent depressive disorder attending a community mental health service

  • Chinedu E. Uzoechina, Pieter Hilvering, Cathryn Rogers, Sinead O'Brien, Ananth Pullela, Mushtaq Yousafzai (a1) and David J. Meagher (a1) (a2)...
Submit a response

eLetters

For whose benefit?

Michael Jan Wise, Consultant Psychiatrist
05 May 2011

Papers highlighting the difficult issue of "off-label prescribing" are always of interest (1). However, in the context of financial restraints and increasing cutbacks, the assertion, taken from the Royal College of Psychiatrist guidelines, that such a modus operandi of prescribing requires frequent monitoring may be unhelpful (2). Clearly, several combinations of treatments for depression and other conditions, might be "off-label", yet they continue to be used regularly. Further, they are documented in widely known prescribing protocols e.g. the Maudsley guidelines and CANMET-MD. Some with an arguably more transparent basis than the National Institute for Health and Clinical Excellence (NICE) process for formulating giuidelines. It might be time for psychiatrists to use clinically appropriate, positive-risk "off-label" prescribing, thatas long as an evidence base has been followed, allows for the time interval between reviews to be increased. We should prescribe what makes a difference and not what doesn’t for the benefit of the patient; prescribing should not be for the purpose of containing doctors' anxiety.

1 Uzoechina CE, Hilvering P, Rogers C et al. Off-label Prescribing in people with recurrent depressive disorder attending a community mental health service. The Psychiatrist 35 3 March 2011. 2 Holloway F. ‘Gentleman, we have no money therefore we must think’ – mental health services in hard times.
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *