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Off-Label Use of Antidepressant, Anticonvulsant, and Antipsychotic Medications Among Georgia Medicaid Enrollees in 2001
Hua Chen, M.D., Ph.D.; Jaxk H. Reeves, Ph.D.; Jack E. Fincham, Ph.D.; William K. Kennedy, Pharm.D.; Jeffrey H. Dorfman, Ph.D.; and Bradley C. Martin, Pharm.D., Ph.D.
Objectives: To determine the prevalence of and factors associated with the off-label use of antidepressant, anticonvulsant, and antipsychotic medications.
Method: A retrospective analysis of Georgia Medicaid recipients was conducted. Recipients prescribed antidepressant, anticonvulsant, or antipsychotic medications were identified. Logistic regression analysis was used to identify factors associated with off-label use.
Results: A total of 46,976 (75.42%) antidepressant recipients, 38,497 (80.12%) anticonvulsant recipients, and 21,252 (63.62%) antipsychotic recipients received at least 1 of these medications off-label in 2001. The likelihood of receiving off-label medications increased remarkably with advancing age (> = 65 vs. < 65 years: antidepressant: OR = 5.15, 95% CI = 4.76 to 5.56; anticonvulsant: OR = 4.54, 95% CI = 4.16 to 4.96; antipsychotic: OR = 5.21, 95% CI = 4.82 to 5.63). Although receiving new anticonvulsants launched after 1993 was the strongest predictor (OR = 7.63, 95% CI = 7.07 to 8.23) of receiving off-label anticonvulsant medications, exposure to newer antidepressants and antipsychotics did not confer a higher chance of receiving off-label medications (selective serotonin reuptake inhibitors vs. tricyclic antidepressants: OR = 0.43, 95% CI = 0.40 to 0.45; atypical vs. conventional antipsychotics: OR = 0.76, 95% CI = 0.72 to 0.80).
Conclusions: The off-label use of antidepressant, anticonvulsant, and antipsychotic medications is highly prevalent. Further research to study the effects of off-label use among this high risk subpopulation may be an important step toward defining the scope of and potential for such use.
(J Clin Psychiatry 2006;67:972-982)
Received Nov. 22, 2005; accepted Dec. 21, 2005. From the Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Houston, Tex. (Dr. Chen); the Department of Statistics (Dr. Reeves), the Department of Clinical & Administrative Pharmacy (Drs. Fincham and Kennedy), and the Department of Agricultural and Applied Economics (Dr. Dorfman), University of Georgia, Athens; and the Division of Pharmaceutical Evaluation and Policy, Pharmacy Practice Department, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock (Dr. Martin).
Drs. Chen, Reeves, Fincham, Kennedy, Dorfman, and Martin report no significant commercial or other relationships relevant to the subject of this article.
Corresponding author and reprints: Bradley C. Martin, Pharm.D., Ph.D., Division of Pharmaceutical Evaluation and Policy, Pharmacy Practice Department, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR 72205-7122 (e-mail: BMARTIN@uams.edu).