
A Third of Antidepressants Are Prescribed for Something Else - kristianp
http://digg.com/2017/off-label-antidepressants
======
jdietrich
Drug companies have aggressively and unlawfully marketed off-label use for
decades, with the most egregious examples being psychiatric drugs.

Pfizer were fined $2.3bn for off-label promotion of Bextra, Geodon, Zyvox and
Lyrica. Eli Lilly were fined $1.4bn for off-label promotion of Zyprexa. GSK
were fined $3bn for a slew of misconduct, including off-label promotion of a
dozen drugs. AstraZeneca were fined $520m for off-label promotion of Seroquel.
Abbott were fined $800m for off-label promotion of Depakote. Novartis were
fined $422m for off-label promotion of Trileptal.

Despite these huge fines, the unlawful marketing continues. I don't think
we're taking the issue nearly seriously enough. For years, drug companies have
been telling (and even bribing) doctors to prescribe drugs with serious side-
effects to vulnerable patients based on no real evidence.

There's a deep malaise at the heart of the pharmaceuticals industry. Marketing
has become the core function of many drug companies. Blatantly fraudulent
marketing is endemic. Drug companies are chalking up billion dollar fines as a
cost of doing business.

I urge you to read the GSK settlement agreement. They admitted to promoting
the prescription of Paxil to children, while having no evidence of efficacy
and hiding evidence that it increased the risk of suicide. They admitted to
hiding evidence that Avandia increased the risk of congestive heart failure
and myocardial infarction. They admitted to bribing doctors to prescribe half
a dozen drugs for off-label use.

This level of corruption would be outrageous in the developing world, let
alone the richest country on earth.

[https://www.justice.gov/opa/pr/glaxosmithkline-plead-
guilty-...](https://www.justice.gov/opa/pr/glaxosmithkline-plead-guilty-and-
pay-3-billion-resolve-fraud-allegations-and-failure-report)

------
ekianjo
Thats because antidepressant is just one of the many activities of such class
of drugs. Its like saying that Viagra is a pulmonary hypertension drug,
prescribed for something else. Indications are not binary things.

~~~
ianai
Not to mention chronic conditions can easily depress someone.

~~~
glastra
As true as that might be, I strongly believe depression as a disease/condition
should only be diagnosed (and thus treated) if there is no _real_ cause for
the symptoms.

Being sad and unable to leave the bed because (your dog died | you are
morbidly obese | you are going to die in 3 months) doesn't qualify as
depression.

~~~
bonesss
Respectfully: the entire mental health profession and the DSM-5 explicitly
disagree with your belief.

Conflating depression with "being sad" is to misunderstand what depression is,
what sadness is, and how we qualify depression diagnoses. Sadness is natural
and healthy. Depression is natural and _unhealthy_.

While the word 'depression' is abused in pop culture, showing enough symptoms
of major depressive disorder over a long enough timeline is the literal
textbook definition of being depressed.

Not getting out of bed because your dog died is arguably a natural reaction to
sadness. Not getting out of bed for three months, refusing to eat because
you're trying to die, cutting off lifelong friends, and undergoing severe
personality changes because your dog died is really, really, something else.

And, on a personal note, distinguishing between what is and isn't a "real"
cause for a feeling is a pretty offensive judgment and implies a very
dismissive attitude towards peoples pain... I mean, someone who is unable to
function in society 15 years after their kid died doesn't get to be depressed
because they have a "real" reason to feel bad? And people who kill themselves
from a major cognitive imbalance don't have a "real" cause for feeling that
way? Bleh. That's a half step removed from "suck it up" or "snap out of it".

~~~
glastra
I haven't conflated sadness with depression. I was _in fact_ stating the
opposite.

Unfortunately I am very aware of most of the symptoms of depression as I have
suffered it myself in the past. And yes, I did take antidepressants. I am not
against their use at all, only against misdiagnoses.

15 years of mourning the death of a loved one is of course abnormal, as I have
stated already in another response around this thread, but... is it
depression? Or is it lack of coping mechanisms? Maybe learning to face reality
is better than depending on a daily dose?

~~~
samirillian
Not a doctor, but: it seems the real problem with your claim is that it's
patently absurd to say that a symptom can only be a symptom if it has no
cause. Symptoms present themselves that we might find the cause of the
problem.

Do you mean no cause other than a chemical imbalance? I still think that's
shaky ground, but I don't really know enough to say.

------
cthalupa
I recently started suffering from chronic headaches that usually start in the
morning when I wake up, and come and go throughout the day. After getting an
MRI and ruling out a brain tumor, we've been trying a variety of medications
to take care of it.

The most successful so far is an anti-depressant. Duloxetine. SNRI. I do have
some of the side effects - my libido is markedly decreased, but it was fairly
high to begin with, so I'm probably at about low-average now. I can still get
in the mood on demand, and still want to initiate several times a week, so I'm
more than happy to make the trade off to not have a basically constant
headache 80% of my waking hours.

Off label prescription is a pretty common thing. Personally, I'm glad for it.

~~~
paul
This may interest you: [https://techcrunch.com/2017/10/08/curing-the-
incurable/](https://techcrunch.com/2017/10/08/curing-the-incurable/)

~~~
cthalupa
Thankfully, mine are more of a mild annoyance than cripplingly painful.

I'll check out Curable though, thank you!

------
djsumdog
I'm actually more surprised to see original content on digg .. and to see digg
for that matter, than the actual content of the article.

~~~
jkuria
Same here. Surprised that Digg still exists! Remember the Digg vs. Reddit Wars
of 2006?

~~~
RantyDave
I don't think there was a war: Reddit started growing, and Digg shot itself in
the face.

------
code4tee
Some anti-smoking drugs are actually just antidepressants sold under a
different brand name. It’s literally exactly the same drug with a different
name stamped on the pills, but it’s easier to get people to take the drug if
they think it’s a “pill to help you quit smoking” and not an “anti depressant”

~~~
fatbird
In my experience, they were quite upfront about the fact that it was an anti-
depressant that had the effect of aiding quitting smoking, because it fairly
obviously dealt with the predictable effects of trying to quit smoking:
anxiety, depression, irritability. You're making it sound like a stealth SSRI
channel, and it's not.

~~~
yeukhon
I am not sure if all physicans have adequate training on psychoatic drugs, but
giving SSRI to a patient with both bipolar and personality disorder can have
very negative effects. So if a non-psychiatrist prescribing antidepressant to
someone without adequate psychatric evaluation (and evaluation can be off
too), you can end up making the patient ill.

So if I were given SSRI to quit smoking, my mental health may get even more
worse.

Disclaimer: have bipolar and personality disorder.

~~~
fatbird
I understand. I also understand that even with a psychiatrist prescribing it
appropriately, with full evaluation and diagnosis for depression, a particular
SSRI can make the patient worse, not better. I've had friends spend years
working through various prescriptions (and combinations) to find what worked,
and it often included some hellish periods when they felt far worse until they
hit on the right drug(s).

~~~
yeukhon
Yeah. In fact, I think psychotic prescription is a trial and error treatment.
It sucks.

------
xkcd-sucks
Yeah, this is a consequence of the fact that "antidepressant" is a marketing
word, not a physically descriptive word.

~~~
saas_co_de
Yes, drugs have all kinds of secondary effects, and some may be useful for
many things. (aspirin being the most notorious)

Once you test something out on enough people it becomes much easier to find
these patterns of secondary effects.

It is actually kind of unfortunate that because of the stigma associated with
mental illness some patients will refuse to take anti-depressants when
prescribed for other conditions where they could be helpful.

------
mhalle
Two other interesting examples:

Trazadone is one of the most commonly prescribed insomnia medications. It
isn't FDA approved for that. It is a decade's old generic antidepressant. The
sleep dose is much less than the regulated theraputic dose.

Through mechanisms not fully understood, people with liver disease often
experience intense skin itching. Standard dermatology approaches have
essentially no effect. SSRIs are one well tolerated treatment.

In neither case is their obvious profit motive or overselling by drug
companies.

~~~
frgtpsswrdlame
Sure but _shouldn 't_ those drugs undergo FDA approval for those uses? You
make it sound as if they're very effective without many side effects so (as
far as FDA approvals go) it shouldn't be too hard.

~~~
mhalle
No, I was just noting two other examples.

------
aristus
This is not in the least remarkable. The article does not mention it, but
several maoi inhibitor drugs are effective for common varieties of epilepsy
and have been used for decades.

~~~
roma1n
Yup, most drugs used in psychiatry also have indications for neurologic
conditions.

------
Lerc
Here's an interesting counterpoint to the anecdote at the start of the story.
I have chronic treatment resistant depression. Gone through many different
treatments. The thing that works best for me is a treatment I receive for
something else. A THF-alpha inhibitor (in my case Etanercept), so I'm in
practically the opposite position to the guy in the article.

I suspect there's a link in some form of branch of depression that comes with
the autoimmune grab bag of fun.

------
evanbishop
I am glad that Briggs could heal his ulcerative colitis with an unorthodox
treatment.

"On occasions when she stopped taking bupropion, the blood and abdominal pain
returned until she started taking the drug again."

Yet I guess I am unimpressed when I hear that symptoms diminish with use of a
drug like bupropion. Eventually when the patient gets tired of the side
effects they will get off the medication. This will leave them with the return
of the illness they used the drug to treat in addition to the damage it caused
in other parts of the body. Masking symptoms is sort of psychiatry's gambit so
I guess this is nothing new.

------
Nomentatus
Tricyclics in general are very powerful antihistamines (this may be the real
reason they work, for some in fact.)

Ginger is also a very powerful antihistamine - comparable to drugs - with
fewer side effects, however.

------
harimau777
Just asked a retired pharmacist and clinical social worker (two family
members) about this. They said that there were numerous things that anti-
depressants are prescribed for (smoking cessation, OCD, anxiety, etc.) which
are NOT off-label uses.

------
phkahler
Crohn's can also be improved with Glycine according to someone I know who
started taking it for other reasons. A bit of googling then showed there may
well be a connection, so the result made some sense. YMMV of course.

------
rootw0rm
I can't take an article about drugs seriously if it's written by someone who
takes antidepressants for depression/anxiety.

------
skimaskninja87
My mother had a stroke and was prescribed Clonazepam for her nerves and
anxiety from the after effects.

~~~
gozur88
Different class of drugs.

------
jokoon
It's because antidepressant are a miracle drug. Sedentary work weeks and
normative society will always drain your energy and kill your soul.

I have the opinion that most people should use antidepressants.

------
mikestew
I figured it was going to be something like Wellbutrin to quit smoking which,
while off-label, kinda makes sense. But IBD? Can’t say I saw that coming.
Because I’m not all that interested in the topic I just skimmed, but I gather
it is not well understood why such wildly off-label use works? (And “no, go
read the article” is acceptable. :-) )

~~~
astura
Um... Smoking cessation is not an off-label use of bupropion (Wellbutrin),
it's an FDA approved use and it's very openly marketed as such.

As far as the reason it seems to work, that was given as:

>Studies on mice had shown that instead of blocking the action of inflammatory
proteins, bupropion appeared to lower the production of those proteins in the
first place.

Bupropion also FDA approved for weight loss when mixed with the opioid
antagonist naltrexone (brand-name Contrave).

No use "make sense" more or less than any other use use, it's a substance that
has lots of effects on the body.

~~~
mikestew
_Um... Smoking cessation is not an off-label use of bupropion (Wellbutrin)_

It was twenty some years ago when I took it. I obviously haven’t kept up with
the latest, but a quick search says FDA approval came shortly after it was
prescribed to me. Mea culpa.

And thanks for the answer.

