Evidence of Prescription of Antidepressants for Non-psychiatric Conditions in Primary Care

An Analysis of Guidelines and Systematic Reviews

Alain Mercier; Isabelle Auger-Aubin; Jean-Pierre Lebeau; Matthieu Schuers; Pascal Boulet; Jean-Loup Hermil; Paul Van Royen; Lieve Peremans


BMC Fam Pract. 2013;14(55) 

In This Article


Antidepressants (ADs) are commonly prescribed in primary care (PC). Among the general population, the 12 month prevalence of ADs consumption ranges from 6% to nearly 10%.[1,2] The main indications for ADs are major depressive episodes and anxiety. Over the past 20 years, the use of ADs has grown extensively. Most studies have shown a high level of consumption in all industrialised countries. In France, between 1980 and 2008, AD sales increased sevenfold, from €84 million to €525 million per year.[3] Selective Serotonin Reuptake Inhibitors (SSRIs) and Selective Norepinephrine Reuptake Inhibitors (SNRIs) accounted for about 80% of sales. Data in various industrialised countries showed similar results.[4–7] In the United States, ADs are the third most commonly prescribed medication.[8,9] This growing prescription rate is a source of concern for healthcare providers and healthcare economists alike.[8,10] The explanations for this high prescription rate remain unclear, with little consensus, and the reasons behind the phenomenon remain largely unknown.[11,12] According to the literature, there are two main causes for this situation. The first is over-prescription for psychiatric conditions. Evidence does not show ADs to be highly clinically effective in treating moderate depression, which is frequently encountered in PC settings, although several recent studies have found that ADs could possibly be beneficial in treating milder episodes.[13,14] ADs are sometimes discontinued too early or prescribed too long.[15,16] Assessing the potential benefit of AD prescription seems to be a challenge, as the variations in measurement specifications in the studies impact the conclusions that are drawn about treatment of depression.[17] The second reason is the prescription of ADs for "non-psychiatric conditions". Growing evidence points to ADs being frequently prescribed for conditions or health problems outside the field of psychiatry.[18] Some observational data suggest that this proportion varies between 25% and 60%.[19,20] Exploratory research has confirmed that GPs prescribe ADs for many non-psychiatric conditions and off-label uses. In many fields, GPs used their feelings and feelings on the products' efficacy rather than scientific evidence to prescribe..[21] The aim of this study was to review the level of evidence for the prescription for ADs in non-psychiatric PC conditions in order to help GPs in their daily practice.