SSRI ‘Indication Creep’ Relies on Negligent Doctors
A report on antidepressant consumption released on 18 February 2014 by the Organisation for Economic Cooperation and Development (OECD) shows huge increases in prescribing of the drugs across most countries. According to the report a key factor driving this increase is the expansion of the off-label use of the drugs for a vastly increased number of indications. While this may not seem like news, I think it warrants some analysis because I think what we are seeing is something more complex than simple market expansion.
In my view what we are seeing is a strategic rebranding of antidepressants as treatments for non-psychiatric conditions which could only occur in an environment where doctors have a criminal disregard for patient safety while knowing they will not be held accountable for patient harm. While the development of a new product often entails sacrificing sales from an existing product, the willingness of doctors to prescribe off label in the absence of any evidence of their effectiveness or safety allows pharmaceutical companies to maintain and even expand their revenues from SSRIs while replacing them with newer drugs and biologics.
After a very long period in which the development of psychiatric drugs involved little in the way of identification of novel agents, pharmaceutical companies and leading universities are now publishing large numbers of studies and issuing media releases telling us they are working on developing, or have developed, a range of new treatments for depression. In a delicate balancing act, big pharma are highlighting the lack of efficacy of antidepressants as a way of promoting their new treatments but remaining silent on their adverse effects so as not to undermine their prescription for non-psychiatric conditions.