Reducing off-label prescribing in psychiatry

Ian B Hickie
Med J Aust 2014; 200 (2): . || doi: 10.5694/mja14.00050
Published online: 3 February 2014

Practitioners need to consider the evidence for pharmacological options before prescribing medications off label

There are few more controversial topics in mental health than what constitutes evidence-based prescribing. Medications not indicated for common conditions like anxiety or depression, or particular age groups such as the young or old, are often prescribed for these conditions or age groups. Consequently, strident calls for clamping down on such “off-label” prescribing are common. Three drivers are behind these public and professional concerns.

  • Brain and Mind Research Institute, University of Sydney, Sydney, NSW.


Competing interests:

I am a National Health and Medical Research Council Senior Principal Research Fellow and a National Mental Health Commissioner. I was a director of headspace, the national youth mental health foundation, until 2012. I have led community-based and pharmaceutical industry-supported education programs related to anxiety, depression and psychosis. Current investigator-initiated studies in depression and circadian systems at the Brain & Mind Research Institute are supported by Servier. I have received honoraria or travel support for participation in educational seminars related to depression, youth mental health or circadian rhythms research and clinical practice.

  • 1. Freedman R, Lewis DA, Michels R, et al. The initial field trials of DSM-5: new blooms and old thorns. Am J Psychiatry 2013; 170: 1-4.
  • 2. Hyman SE. Diagnosing the DSM: diagnostic classification needs fundamental reform. Cerebrum 2011; (March): 6.
  • 3. Hickie IB, Scott J, Hermens DF, et al. Clinical classification in mental health at the cross-roads: which direction next? BMC Med 2013; 11: 125-138.
  • 4. Slade T, Johnston A, Oakley Browne MA, et al. 2007 National Survey of Mental Health and Wellbeing: methods and key findings. Aust N Z J Psychiatry 2009; 43: 594-605.
  • 5. Rosenberg S, Hickie I. How to tackle a giant: creating a genuine evaluation of the Better Access Program. Australas Psychiatry 2010; 18: 496-502.
  • 6. Stephenson CP, Karanges E, McGregor IS. Trends in the utilisation of psychotropic medications in Australia from 2000 to 2011. Aust N Z J Psychiatry 2013; 47: 74-87.
  • 7. Pan A, Sun Q, Okereke OI, et al. Use of antidepressant medication and risk of type 2 diabetes: results from three cohorts of US adults. Diabetologia 2012; 55: 63-72.
  • 8. Citrome L, Collins JM, Nordstrom BL, et al. Incidence of cardiovascular outcomes and diabetes mellitus among users of second-generation antipsychotics. J Clin Psychiatry 2013; 74: 1199-1206.
  • 9. Buchanan RW, Keefe RS, Umbricht D, et al. The FDA-NIMH-MATRICS guidelines for clinical trial design of cognitive-enhancing drugs: what do we know 5 years later? Schizophr Bull 2011; 37: 1209-1217.
  • 10. Insel T, Cuthbert B, Garvey M, et al. Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry 2010; 167: 748-751.


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