A Third of Antidepressants Are Prescribed for Something Else

http://digg.com/2017/off-label-antidepressants

by kristianp • 9 years ago

98 63 9 years ago

cthalupa4• 9 years ago

I recently started suffering from chronic headaches that usually start in the morning when I wake up, and come and go throughout the day. After getting an MRI and ruling out a brain tumor, we've been trying a variety of medications to take care of it.

The most successful so far is an anti-depressant. Duloxetine. SNRI. I do have some of the side effects - my libido is markedly decreased, but it was fairly high to begin with, so I'm probably at about low-average now. I can still get in the mood on demand, and still want to initiate several times a week, so I'm more than happy to make the trade off to not have a basically constant headache 80% of my waking hours.

Off label prescription is a pretty common thing. Personally, I'm glad for it.

paul• 9 years ago

This may interest you: https://techcrunch.com/2017/10/08/curing-the-incurable/

cthalupa4• 9 years ago

Thankfully, mine are more of a mild annoyance than cripplingly painful.

I'll check out Curable though, thank you!

napsterbr• 9 years ago

When I started taking duloxetine, I've experienced most or all of the side effects in the first ~4 weeks. After that they all went away. A friend of mine also had the same experience.

This is a small data point but who knows, not sure how recently you started taking the meds but there is a chance all the side effects will vanish :)

cthalupa4• 9 years ago

Glad to hear they went away!

The side effects are pretty mild, though if I miss a dose the headache I get after is usually amplified.

sjg007• 9 years ago

I’m curious if you’re tracking your blood pressure? Both before and after starting the medication. Did you see any change? I’ve wondered if there’s a relationship between blood pressure and headaches.

cthalupa4• 9 years ago

No change - sits right around 120/80

There's definitely a relationship, though - high blood pressure can cause headaches

joejerryronnie• 9 years ago

Have you looked into teeth grinding during the night/throughout the day? I know, it seems like an obvious thing to look into (your dentist can tell if you've been grinding your teeth within the first couple minutes of an appt), but this unconscious behavior can cause low dull headaches throughout the day. An oral appliance (i.e. night guard) can have a tremendous positive impact on preventing daily headaches.

xkcd-sucks• 9 years ago

Yeah, this is a consequence of the fact that "antidepressant" is a marketing word, not a physically descriptive word.

saas_co_de• 9 years ago

Yes, drugs have all kinds of secondary effects, and some may be useful for many things. (aspirin being the most notorious)

Once you test something out on enough people it becomes much easier to find these patterns of secondary effects.

It is actually kind of unfortunate that because of the stigma associated with mental illness some patients will refuse to take anti-depressants when prescribed for other conditions where they could be helpful.

phkahler• 9 years ago

Crohn's can also be improved with Glycine according to someone I know who started taking it for other reasons. A bit of googling then showed there may well be a connection, so the result made some sense. YMMV of course.

mikestew2• 9 years ago

I figured it was going to be something like Wellbutrin to quit smoking which, while off-label, kinda makes sense. But IBD? Can’t say I saw that coming. Because I’m not all that interested in the topic I just skimmed, but I gather it is not well understood why such wildly off-label use works? (And “no, go read the article” is acceptable. :-) )

astura• 9 years ago

Um... Smoking cessation is not an off-label use of bupropion (Wellbutrin), it's an FDA approved use and it's very openly marketed as such.

As far as the reason it seems to work, that was given as:

Studies on mice had shown that instead of blocking the action of inflammatory proteins, bupropion appeared to lower the production of those proteins in the first place.

Bupropion also FDA approved for weight loss when mixed with the opioid antagonist naltrexone (brand-name Contrave).

No use "make sense" more or less than any other use use, it's a substance that has lots of effects on the body.

mikestew2• 9 years ago

Um... Smoking cessation is not an off-label use of bupropion (Wellbutrin)

It was twenty some years ago when I took it. I obviously haven’t kept up with the latest, but a quick search says FDA approval came shortly after it was prescribed to me. Mea culpa.

And thanks for the answer.

aristus• 9 years ago

This is not in the least remarkable. The article does not mention it, but several maoi inhibitor drugs are effective for common varieties of epilepsy and have been used for decades.

roma1n• 9 years ago

Yup, most drugs used in psychiatry also have indications for neurologic conditions.

djsumdog• 9 years ago

I'm actually more surprised to see original content on digg .. and to see digg for that matter, than the actual content of the article.

jkuria• 9 years ago

Same here. Surprised that Digg still exists! Remember the Digg vs. Reddit Wars of 2006?

RantyDave2• 9 years ago

I don't think there was a war: Reddit started growing, and Digg shot itself in the face.

ajdlinux• 9 years ago

Remember the Digg vs Slashdot wars as well?

Shikadi• 9 years ago

I member

boomboomsubban• 9 years ago

"This article was first published by Wellcome on Mosaic and is republished here under a Creative Commons license"

ekianjo• 9 years ago

Thats because antidepressant is just one of the many activities of such class of drugs. Its like saying that Viagra is a pulmonary hypertension drug, prescribed for something else. Indications are not binary things.

ianai• 9 years ago

Not to mention chronic conditions can easily depress someone.

hacknat• 9 years ago

Not to mention mood disorders are still not well understood. Anxiety and Depression actually manifest different symptoms in other cultures.

glastra3• 9 years ago

As true as that might be, I strongly believe depression as a disease/condition should only be diagnosed (and thus treated) if there is no real cause for the symptoms.

Being sad and unable to leave the bed because (your dog died | you are morbidly obese | you are going to die in 3 months) doesn't qualify as depression.

0xcde4c3db• 9 years ago

Similarly, most OTC sleeping pills are just first-generation antihistamines like diphenhydramine with a different brand name on the label. Incidentally, diphenhydramine is also an SSRI, and the discovery of that fact led to the development of Prozac and its derivatives.

geoelectric• 9 years ago

Diphenhydramine is an SRI but not an SSRI. It inhibits serotonin reuptake, but doesn't select for it--it acts on other receptors as well.

code4tee• 9 years ago

Some anti-smoking drugs are actually just antidepressants sold under a different brand name. It’s literally exactly the same drug with a different name stamped on the pills, but it’s easier to get people to take the drug if they think it’s a “pill to help you quit smoking” and not an “anti depressant”

jackhack• 9 years ago

anti-anxiety meds, to be precise. reducing anxiety reduces the drive to smoke. it was discovered ass a side-effect during clinical trials, that many subjects spontaneously quit smoking.

fatbird2• 9 years ago

In my experience, they were quite upfront about the fact that it was an anti-depressant that had the effect of aiding quitting smoking, because it fairly obviously dealt with the predictable effects of trying to quit smoking: anxiety, depression, irritability. You're making it sound like a stealth SSRI channel, and it's not.

yeukhon2• 9 years ago

I am not sure if all physicans have adequate training on psychoatic drugs, but giving SSRI to a patient with both bipolar and personality disorder can have very negative effects. So if a non-psychiatrist prescribing antidepressant to someone without adequate psychatric evaluation (and evaluation can be off too), you can end up making the patient ill.

So if I were given SSRI to quit smoking, my mental health may get even more worse.

Disclaimer: have bipolar and personality disorder.

RantyDave2• 9 years ago

In the UK, buproprion can only be prescribed for (cessation of) smoking.

kps• 9 years ago

What do UK doctors do about SSRI-induced anorgasmia?

bluepirate• 9 years ago

I was prescribed buproprion to help me quit tobacco. It was extremely effective. I don't think the reduction in aniexty was the main driver though. In my experience, I physically felt sick every time I tried to smoke. It was a really unpleasant experience, but it helped immensely.

freeflight• 9 years ago

That doesn't surprise me the least, there's quite a bit of evidence [0] that many smokers smoke to treat psychological issues. Which would also explain why some people have a much easier time kicking the habit while others struggle really hard just with the thought of giving up.

As somebody who's been suffering from depression his whole life, atop a few other mental issues, it's really disheartening to realize how little we seem to actually know about how the human psyche and brain work.

[0] https://slatestarcodex.com/2016/01/11/schizophrenia-no-smoki...

Nomentatus• 9 years ago

Tricyclics in general are very powerful antihistamines (this may be the real reason they work, for some in fact.)

Ginger is also a very powerful antihistamine - comparable to drugs - with fewer side effects, however.

skimaskninja87• 9 years ago

My mother had a stroke and was prescribed Clonazepam for her nerves and anxiety from the after effects.

rootw0rm2• 9 years ago

that's not offlabel tho, that's textbook benzo usage.

gozur88• 9 years ago

Different class of drugs.

rootw0rm2• 9 years ago

I can't take an article about drugs seriously if it's written by someone who takes antidepressants for depression/anxiety.

Lerc• 9 years ago

Here's an interesting counterpoint to the anecdote at the start of the story. I have chronic treatment resistant depression. Gone through many different treatments. The thing that works best for me is a treatment I receive for something else. A THF-alpha inhibitor (in my case Etanercept), so I'm in practically the opposite position to the guy in the article.

I suspect there's a link in some form of branch of depression that comes with the autoimmune grab bag of fun.

jokoon• 9 years ago

It's because antidepressant are a miracle drug. Sedentary work weeks and normative society will always drain your energy and kill your soul.

I have the opinion that most people should use antidepressants.

jdietrich2• 9 years ago

Drug companies have aggressively and unlawfully marketed off-label use for decades, with the most egregious examples being psychiatric drugs.

Pfizer were fined $2.3bn for off-label promotion of Bextra, Geodon, Zyvox and Lyrica. Eli Lilly were fined $1.4bn for off-label promotion of Zyprexa. GSK were fined $3bn for a slew of misconduct, including off-label promotion of a dozen drugs. AstraZeneca were fined $520m for off-label promotion of Seroquel. Abbott were fined $800m for off-label promotion of Depakote. Novartis were fined $422m for off-label promotion of Trileptal.

Despite these huge fines, the unlawful marketing continues. I don't think we're taking the issue nearly seriously enough. For years, drug companies have been telling (and even bribing) doctors to prescribe drugs with serious side-effects to vulnerable patients based on no real evidence.

There's a deep malaise at the heart of the pharmaceuticals industry. Marketing has become the core function of many drug companies. Blatantly fraudulent marketing is endemic. Drug companies are chalking up billion dollar fines as a cost of doing business.

I urge you to read the GSK settlement agreement. They admitted to promoting the prescription of Paxil to children, while having no evidence of efficacy and hiding evidence that it increased the risk of suicide. They admitted to hiding evidence that Avandia increased the risk of congestive heart failure and myocardial infarction. They admitted to bribing doctors to prescribe half a dozen drugs for off-label use.

This level of corruption would be outrageous in the developing world, let alone the richest country on earth.

https://www.justice.gov/opa/pr/glaxosmithkline-plead-guilty-...

harimau777• 9 years ago

Just asked a retired pharmacist and clinical social worker (two family members) about this. They said that there were numerous things that anti-depressants are prescribed for (smoking cessation, OCD, anxiety, etc.) which are NOT off-label uses.

mhalle2• 9 years ago

Two other interesting examples:

Trazadone is one of the most commonly prescribed insomnia medications. It isn't FDA approved for that. It is a decade's old generic antidepressant. The sleep dose is much less than the regulated theraputic dose.

Through mechanisms not fully understood, people with liver disease often experience intense skin itching. Standard dermatology approaches have essentially no effect. SSRIs are one well tolerated treatment.

In neither case is their obvious profit motive or overselling by drug companies.

frgtpsswrdlame• 9 years ago

Sure but shouldn't those drugs undergo FDA approval for those uses? You make it sound as if they're very effective without many side effects so (as far as FDA approvals go) it shouldn't be too hard.

mhalle2• 9 years ago

No, I was just noting two other examples.

DougWebb• 9 years ago

My ex-wife had intense skin itching. We didn't realize that her transplanted liver had started failing. A neighbor happened to notice her scratching, and happened to know about the liver disease connection, and happened to mention it. After some tests to confirm her liver was failing her meds were adjusted to slow the process down. It failed several years later anyway (she survived a second liver transplant) but without proper treatment it would've failed much sooner.

I always say to be wary of treating symptoms instead of underlying causes. Taking an antidepressant to soothe intense skin itching can kill you, if that's all you're doing for it. Your dermatologist may not know any better, or may not care.

evanbishop• 9 years ago

I am glad that Briggs could heal his ulcerative colitis with an unorthodox treatment.

"On occasions when she stopped taking bupropion, the blood and abdominal pain returned until she started taking the drug again."

Yet I guess I am unimpressed when I hear that symptoms diminish with use of a drug like bupropion. Eventually when the patient gets tired of the side effects they will get off the medication. This will leave them with the return of the illness they used the drug to treat in addition to the damage it caused in other parts of the body. Masking symptoms is sort of psychiatry's gambit so I guess this is nothing new.

A Third of Antidepressants Are Prescribed for Something Else

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