Evaluation of patterns and predictors of off-label prescribing of antidepressants in psychiatry at a tertiary care hospital - An analytical cross-sectional study

Abstract

Background: Off-label drug prescribing is commonly seen all medical fields including psychiatry. A regular auditing and publishing of off-label drug prescribing is important as it provides strong scientific evidence for the clinicians on the effectiveness and acceptability of these proposed treatments. Aims and Objective: To evaluate the pattern and predictors of off-label prescribing of antidepressants in psychiatry was taken up. Materials and Methods: After obtaining the permission from Institutional Ethics Committee, an analytical cross-sectional study was conducted among patients attending psychiatry outpatient department for 6 months. Demographic and drug data were noted and analyzed for off-label drug use as per Food Drug Administration approved indication. Chi-square test and Student’s t-test were used to compare the off-label and approved indication groups. Multivariate binary logistic regression model was used to determine the predictors of offlabel prescribing. Results: A total of 238 antidepressants were prescribed for 200 patients, of which 42.8% were used for off-label indication. Fluoxetine 44.1% and escitalopram 42.1% were the most frequently prescribed antidepressants in offlabel manner. The off label indications noted was somatoform disorder (12.5%), followed by generalized anxiety disorder (8.5%). There was significant causal association between off-label prescribing and number of antidepressant (odds ratio [OR] - 15.43, 95% confidence interval [CI] - 3.49-89.02, P < 0.05) and non-depressant use (OR - 74.37, 95% CI - 25.4-293.71, P ≤ 0.05). Conclusion: Off-label use of antidepressants was 42.8% in this study. A number of antidepressants and non-depressant uses were the significant predictors of off-label prescribing in our hospital.