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Americans and their physicians often like to solve problems by taking a pill. Tens of millions of Americans take antidepressant pills, however, without having the anxiety or major depression the medications were designed to treat.

Taking a Pill for Depression Used as a Substitute for Time-Consuming Counseling

Researchers accessing data from the Collaborative Psychiatric Epidemiologic Surveys of 20,000 people in the USA queried between 2001 and 2003 found that Americans were receiving antidepressants for sleep problems, erectile dysfunction, relationship problems, loss of appetite, excessive appetite, and hard-to-diagnose aches and pains.

With only a few exceptions, antidepressants are intended for debilitating major depression and sometimes for obsessive-compulsive disorder. But over half of the $9.9 billion in antidepressant drugs prescribed in the United States in 2009, researchers believe, was actually used to treat depression.

The problem with taking a drug for a problem it was not designed to treat is not just the $100 to $200 a month the patient may have to pay out of pocket. It's also the weight gain and sexual dysfunction many antidepressant drugs cause as side effects, and the potential for drug interactions. Taking the St. John's wort that is generally regarded as effective for mild to moderate depression, for example, is not safe while taking Prozac or Zoloft or for four to six weeks after finishing a course of treatment with prescription antidepressants.

Off-Label Use of Antidepressants Is Common

Off-label, or unapproved use of antidepressants is very common. Some of it is even encouraged by the medical establishment.

The Journal of the American Medical Association, for example, recently published a study of the use of the popular antidepressant escitalopram (brand name Lexapro) as a treatment for hot flashes in menopause. Encouraged by the findings reported in the prestigious journal, many doctors now prescribe Lexapro for hot flashes, but without having clear guidance on the right dosage. The doctor has to experiment with the dosage for hot flashes, which may be too much or too little should the woman being treated also develop depression.

The drug Cymbalta, or duloxetine, which is chemically very similar to fluoxetine, known as Prozac, was approved as a treatment for fibromyalgia in 2008. Before the current application of Cymbalta for fibromyalgia, however, Cymbalta was marketed for:

  • Urinary incontinence in women
  • Bladder infections
  • Chronic pain
  • Diabetic neuropathy
  • Chronic fatigue syndrome
  • Generalized anxiety disorder, and, of course
major depression. These attempts came as a respected pharmacology journal asserted:

"There is insufficient published evidence of its comparative efficacy to judge its duloxetine place in depression among many other longer-established antidepressant drugs, or how it compares with other therapy for diabetic peripheral neuropathic pain. Therefore we can see no place for it in either indication."
But research dollars could not be allowed to go waste. For nearly 20 years, the makers of Cymbalta kept looking for applications of the medication that would not compete with their bestseller Prozac. Eventually, they were found.

For many conditions of physical origin, off-label uses of antidepressants may actually be appropriate, even if insurance companies refuse to pay for them. If there is a psychological component to disease, however, sometimes appropriate referrals to a psychologist, occupational therapist, massage therapist, or exercise physiologist will do more good for less long-term expense.

  • "Is there a place for duloxetine?".Drug Ther Bull 45(4): 29–32. April 2007.