Off-Label Prescribing of Psychotropic Medications: A Nationally Representative Survey of Physicians

Purpose: Off-label prescribing of psychotropic medications is known to be quite common. We sought to determine the extent to which antidepressants, anxiolytics, antipsychotics, anti-mania agents, and ADHD medications were so prescribed, including the extent of off-label prescribing for dementia and for disorders commonly diagnosed in childhood.

Methods: We used 2013 National Disease and Therapeutic Index data to determine the extent of off-label prescribing and the extent to which prescribing was for psychiatric or non-psychiatric diagnoses. Using the Clinical Classification Software, psychiatric uses were grouped into categories (e.g., mood disorders, psychosis) and the ten most common non-psychiatric uses for each type of medication were identified. Frequencies were calculated.

Results: The majority of prescribing was for psychiatric purposes (more than 95% of prescriptions for antipsychotics, anti-manics and ADHD medications and over 75% of antidepressants and anxiolytics). Prescribing for non-psychiatric diagnoses was most often seen with anxiolytics (24%) and anti-depressants (8%). Off-label psychiatric prescribing was greatest for anxiolytics (31% of prescriptions) and antipsychotics (19%). Medications most commonly prescribed for dementia and similar disorders were most commonly antipsychotics and antidepressants. Categories of disorders most commonly seen in childhood and adolescence included ADHD, impulse control disorders, developmental disabilities and a miscellaneous group identified as being primarily diagnosed during childhood. Prescribing for these disorders as a group (aside from ADHD medications) was most common with antipsychotics (8.0% of antipsychotic prescriptions) and antidepressants (4.6%).

Implications for Research, Policy and/or Practice: Off-label use of psychotropic medications may be associated with positive outcomes or reduced symptoms not achieved with medications prescribed on-label. This means, however, that clinical testing is necessary to establish safety and efficacy. Without that testing, off-label prescribing may result in unsafe or ineffective treatment. This is concerning, particularly in the treatment of vulnerable populations such as the elderly or children.