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For whose benefit?

Published online by Cambridge University Press:  02 January 2018

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Abstract

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Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Copyright © Royal College of Psychiatrists, 2011

Papers highlighting the difficult issue of ‘off-label prescribing’ are always of interest. Reference Uzoechina, Hilvering, Rogers, O'Brien, Pullela and Yousafzai1 However, in the context of financial restraints and increasing cutbacks, the assertion, taken from the Royal College of Psychiatrists’ guidelines, that such a modus operandi of prescribing requires frequent monitoring may be unhelpful. Reference Holloway2

Clearly, several combinations of treatments for depression and other conditions might be ‘off-label’, yet they continue to be used regularly. Further, they are documented in widely known prescribing protocols such as the Maudsley guidelines and CANMET-MD, some with an arguably more transparent basis than the National Institute for Health and Clinical Excellence process for formulating guidelines. It might be time for psychiatrists to start using clinically appropriate, positive-risk ‘off-label’ prescribing that, as long as an evidence base has been followed, allows for the time interval between reviews to be increased. We should prescribe what makes a difference for the patient; not what contains the prescriber’s anxiety.

References

1 Uzoechina, CE, Hilvering, P, Rogers, C, O'Brien, S, Pullela, A, Yousafzai, M, et al. Off-label prescribing in people with recurrent depressive disorder attending a community mental health service. Psychiatrist 2011; 35: 84–9.CrossRefGoogle Scholar
2 Holloway, F. ‘Gentlemen, we have no money therefore we must think’ – mental health services in hard times. Psychiatrist 2011; 35: 81–3.Google Scholar
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