Off-Label Use of Antipsychotic Medications in the Department of Veterans Affairs Health Care System

Department of Public Health Sciences, Penn State College of Medicine, 600 Centerview Dr., Hershey, PA 17033, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 10/2009; 60(9):1175-81. DOI: 10.1176/
Source: PubMed


This study aimed to determine the prevalence of prescribing antipsychotics to adults without schizophrenia or bipolar disorder and to identify factors associated with such off-label use.
Patients with at least one prescription for an antipsychotic medication from the Department of Veterans Affairs (VA) during fiscal year (FY) 2007 were identified in national VA administrative databases. Rates of off-label antipsychotic use were determined along with average doses. Multivariate logistic regression models identified sociodemographic and clinical characteristics associated with off-label use.
Of the 279,778 individuals in FY 2007 who received an antipsychotic medication, 168,442 (60.2%) had no record of a diagnosis for which these drugs are approved. The most common mental illness diagnoses among patients given prescriptions for antipsychotics off label were posttraumatic stress disorder (PTSD, 41.8%), minor depression (39.5%), major depression (23.4%), and anxiety disorder (20.0%). Among VA patients with mental illness other than schizophrenia or bipolar disorder, the proportion who received prescriptions for antipsychotic medications ranged from a low of 9.1% among patients with adjustment reaction; to about 20% for those with depression, dementia, or PTSD; and to a high of 40.7% among patients with other psychoses. Doses were low, with over half of patients who received off-label quetiapine, risperidone, or first-generation antipsychotics receiving doses below those recommended for schizophrenia. In logistic regression models, patients diagnosed as having other psychosis or dementia had the highest odds of receiving an antipsychotic medication off label.
Off-label use of antipsychotic medications was common. Given that these drugs are expensive, have potentially severe side effects, and have limited evidence supporting their effectiveness for off-label usage, they should be used with greater caution.

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Available from: Somaia Mohamed, Jul 29, 2015
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    08/2015; 229(3):PSYD1500402. DOI:10.1016/j.psychres.2015.08.005
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    • "Globally off-label uses account for up to 65% of all antipsychotic prescriptions [Weiss et al. 2000; Barbui et al. 2004; Hodgson and Belgamwar, 2006; Leslie et al. 2009] with common off-licence uses including depressive and bipolar affective disorders, dementia, especially when complicated by challenging or aggressive behaviour, anxiety disorders, alcohol and drug dependence, personality disorder, post-traumatic stress and pervasive developmental disorders [Leslie et al. 2009]. Quetiapine is the most frequently prescribed offlabel antipsychotic in the US, followed by risperidone and then first-generation medicines [Leslie et al. 2009]. In one modest UK study olanzapine was the most commonly prescribed, and was given for a disorder other than schizophrenia in 134 out of 310 prescriptions [Hodgson and Belgamwar, 2006]. "
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    Therapeutic Advances in Psychopharmacology 08/2013; 3(4):233-43. DOI:10.1177/2045125312472530 · 1.53 Impact Factor
    • "Quetiapine is an atypical antipsychotic indicated for the treatment of schizophrenia, bipolar disorder and major depressive disorder. It has also been used extensively offlabel to treat obsessive-compulsive disorder, post-traumatic stress disorder, restless leg syndrome, autism, alcoholism, anxiety disorders, sleep disorders and Tourette's syndrome (Bogan et al., 2005; Boku et al., 2006; Croissant et al., 2006; Copur et al., 2007; Leslie et al., 2009; Philip et al., 2008; Rowe, 2007; Stachnik & Nunn-Thompson, 2007). Quetiapine's primary mechanism of action is a result of its CNS activity on the serotonergic receptors (5-HT 2 ) as well as the dopaminergic receptors D 1 and D 2 . "
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    ABSTRACT: Background: Quetiapine is an atypical antipsychotic approved for the treatment of schizophrenia, bipolar disorder and major depressive disorder. There has been a growing amount of quetiapine abuse cases in psychiatric patients. The purpose of this article is to analyse these reports to recognize identifiable patterns of quetiapine misuse. Approach: We searched the PubMed, Scopus, Medline/Ovid and GoogleScholar databases for case reports of quetiapine abuse and/or dependence among patients with: bipolar disorder, anxiety disorders, panic disorder, social phobia, generalized anxiety disorder, obsessive-compulsive disorder and substance use/dependence. Findings: The search retrieved 25 cases of quetiapine abuse and/or dependence among psychiatric patients. Higher frequency of abuse/dependence was observed in men and people being in their mid-thirties. Only half of the cases reported a positive history of substance abuse. The most prominent phenomenon associated with quetiapine abuse/dependence was marked withdrawal symptoms. Conclusions: Our research indicates that quetiapine is likely to be abused by male psychiatric patients in their mid-thirties and less than 50% of them having positive history of substance abuse/dependence. Caution should be taken when considering the prescription of quetiapine to that special patient group and close monitoring for drug misuse is needed in the course of the entire treatment period.
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