Treatment Indications for Antidepressants Prescribed in Primary Care in Quebec, Canada, 2006-2015

Abstract

Antidepressant use in the United States has increased over the last 2 decades. 1 A suspected reason for this trend is that primary care physicians are increasingly prescribing antidepressants for nondepressive indications, including unapproved (off-label) indications that have not been evaluated by regulatory agencies. 2 However, the frequency with which physicians prescribe antidepressants for nondepres-sive indications is unknown because treatment indications are rarely documented. We analyzed the prevalence of treatment indications for antidepressants and assessed temporal trends in antidepressant prescribing for depression. Methods | This study used data from the Medical Office of the 21st Century (MOXXI) research platform. 3 MOXXI is an electronic medical record (EMR) and prescribing system that has been used by primary care physicians in community-based, fee-for-service practices around 2 major urban centers in Quebec, Canada. During the study period, approximately 185 physicians (25% of eligible) and 100 000 patients (30% of all who visited a MOXXI physician) gave informed consent to use the EMR and have their information used for research purposes. Vasomotor symptoms of menopause 856 (0.8) 112 (13.1) 736 (86.0) 2 (0.2) 6 (0.7) 856 (100.0) Social phobia 568 (0.6) 434 (76.4) 134 (23.6) 0 (0.0) 0 (0.0) 199 (35.0) Nicotine dependence 514 (0.5) 0 (0.0) 0 (0.0) 0 (0.0) 514 (100.0) 0 (0.0) Attention-deficit/hyperactivity disorder 389 (0.4) 16 (4.1) 4 (1.0) 5 (1.3) 364 (93.6) 389 (100.0) Posttraumatic stress disorder 263 (0.3) 211 (80.2) 35 (13.3) 2 (0.8) 15 (5.7) 207 (78.7) Sexual dysfunction 261 (0.3) 39 (14.9) 2 (0.8) 8 (3.1) 212 (81.2) 261 (100.0) Premenstrual disorders and syndromes 212 (0.2) 193 (91.0) 17 (8.0) 2 (0.9) 0 (0.0) 63 (29.7) Digestive system disorders 119 (0.1) 4 (3.4) 1 (0.8) 114 (95.8) 0 (0.0) 119 (100.0) Urinary system disorders 109 (0.1) 0 (0.0) 2 (1.8) 107 (98.2) 0 (0.0) 100 (91.7) Bulimia nervosa 76 (0.1) 54 (71.1) 0 (0.0) 12 (15.8) 10 (13.2) 22 (29.0) Abbreviations: SNRI, serotonin-norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant. a Among all antidepressant prescriptions, 1.8% had multiple treatment indications recorded and were assigned to multiple categories. As a result, the sum of prescriptions across the individual treatment indication categories exceeds the number of prescriptions for any indication (last row). b Percentages were calculated using the total number of antidepressant prescriptions for any indication (N = 101 759) as the denominator. c Percentages for each pharmacological class were calculated using the total number of prescriptions for the indication as the denominator.