Prescriber intent, off-label usage, and early discontinuation of antidepressants: a retrospective physician survey and data analysis.
BACKGROUND
Many patients discontinue antidepressant therapy long before the 6-month minimum duration recommended for the treatment of major depression and many other diagnoses. We explore various possibilities, including prescriber intent and patient diagnosis, to explain some of this early discontinuation.


METHODS
Patients from a single health maintenance organization who filled at least 1 prescription for an antidepressant during the first 4 months of 2001 and who did not fill an antidepressant prescription in the 6 months prior were identified retrospectively. Prescribers of those patients' antidepressants were surveyed for patient diagnosis and length of intended treatment with antidepressant medication. Actual length of treatment was then obtained from pharmacy data and correlated with survey data and other variables.


RESULTS
Prescriber surveys were returned for 51% (485/951) of the patients identified. Surveys indicated that for 34% of initial antidepressant prescriptions, < 6 months of treatment was intended. Important determinants of the length of antidepressant therapy included prescriber specialty area, number of prescribers, prescriber intent, diagnosis, specific antidepressant used, and concomitant benzodiazepine use.


CONCLUSIONS
Prescriber intention to treat many patients with short courses of antidepressants, often for off-label, non-mental health indications, was correlated with early discontinuation and needs further study of both its rationale and efficacy. Although less prevalent, short-term treatment of mental health disorders, including depression, was also intended by psychiatrists and other prescribers. The widespread practice of intended short-term treatment with antidepressants needs to be understood better, since it results in guideline-incompatible, early antidepressant discontinuation.
Pomerantz
Jay M
JM
Health New England, Springfield, MA, USA. jayp@map.com
Finkelstein
Stan N
SN
Berndt
Ernst R
ER
Poret
Amy W
AW
Walker
Leon E
LE
Alber
Robert C
RC
Kadiyam
Vidya
V
Das
Mitali
M
Boss
David T
DT
Ebert
Thomas H
TH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000145:classification / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000628:therapy; D004348:Drug Labeling; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D033182:Intention; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010820:Physicians; D011613:Psychotherapy; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data*
D000928:Antidepressive Agents