Off-label prescriptions occur when a physician assigns a drug to treat a condition that it is not approved for. In most instances there may be some preliminary evidence, but it still operates with an extra element of uncertainty. The CBC covered a report that criticized this practice for antipsychotic medications. The drugs are approved for disorders like schizophrenia, but have seen increased use for depression and other conditions that they are not approved for.
Using the drugs “off label’ for conditions other than their original approval is perfectly legal but causes concern among some experts. A 2001 report by the AHRQ concluded that about 21 percent of prescribed drug use was for conditions not indicated on the label.
Although the practice is legal, some groups believe that it exposes patients to significant side-effects without sufficient scientific evidence about the potential benefits.
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2 Comments to
“Off-Label Antipsychotic Use”
My experience with being prescribed Zyprexa for depression (an off-label use) is that it worked–it made me fat, but it worked. My shrink tried it after two years of other drugs. She indicated that I was difficult to treat, but as the human on the receiving end, I could tell that I was completely a guinea pig. She prescribed zyprexa because of some article she read that indicated that it could be useful with people who had depression that was recalcitrant (although that isn’t the word she used). I learned from the treatment process that the entire prescription industry, at least when it comes to mental health, is a combination of trial and error. When placebos work as well as prescription drugs, it’s difficult to have faith in the drugs.
Yes, this is the “science” of psychology. When self reported survey data shows that more of the folks in the test said positive things about a particular drug compared to placebo, or another drug, it becomes accepted as a treatment for that condition.
Of course, they do not really know why it would work, or what they are doing to your brain, but based on the survey they can prescribe the drug.
Science? I like your description “trial and error” because if you are in the proportion of the sample where it doesn’t work, of course, no benefit. But what about those who reported some benefit? What are they saying, really? Are they saying they feel something different because of the drug? What is different? Is it a sort of buzz feeling that makes it seem easier to be depressed, or is it something that actually makes you happier? What are these drugs doing? I would like to see a lot of open-ended, qualitative discovery research about what people are experiencing on these various drugs. What do they feel? What is working or not working?
Of course, in reality, it would be nice if the science of how the brain works could catch up with the stuff being prescribed. Some day, I believe it will, and we may find out what we (as a society) were actually doing with these drugs.
Until then, it is trial and error, where the patient gets to decide, in the end, which drug they like the best. Science.
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Last reviewed: By John M. Grohol, Psy.D. on 21 Jan 2007
