If you’re taking an antidepressant, there’s a good chance it’s not necessarily for depression.
According to recent data released by the National Center for Health Statistics, antidepressants are the third most common prescription drug taken by Americans. However, not all these drugs are administered to patients for depression and anxiety – nor does a psychiatrist always prescribe them. Instead, doctors say, antidepressants are often recommended to patients by primary care physicians and are used to treat a surprising assortment of non-psychological conditions. The exact frequency that this occurs, says David Diaz, an assistant professor of clinical psychiatry at Indiana University School of Medicine, isn’t known. Although there are no hard numbers, Diaz believes that perhaps “about a half – maybe a third – of [antidepressants’ use] are for these other reasons.”
These antidepressants are often prescribed “off-label,” Diaz says, meaning they’re being used in a way not specified in the Food and Drug Administration-approved packaging label. But “just because the medication is off-label does not mean it’s being used experimentally,” Diaz says. “In many cases, it’s the community standard.”
From insomnia to irritable bowl treatment, here’s a list of some of the most common – and unexpected – uses for antidepressants:
“Sleep is always a tricky beast – especially these days, where things are so 24/7,” says Todd Christiansen, a child and adolescent psychiatrist who practices in the District of Columbia metro area. “An antidepressant medication that can be used for sleep – trazodone – is probably one of the better ones out there.” According to Christiansen, trazodone (once called Desyrel, now sometimes sold as Oleptro) was originally designed as an antidepressant. But due to the drug’s nature, patients had to take very high doses for it to effectively combat depression and anxiety. Low doses, however, can induce sleep. Nowadays, trazodone is most often prescribed off-label for insomnia. Unlike other sleep aides, it’s not a benzodiazepine or a narcotic. Therefore, it’s not addicting or habit-forming.
Another antidepressant drug called amitriptyline, which was once marketed as Elavil, is also used for sleep, Christiansen says. It’s “terribly sedating,” he says. Like trazodone, patients take a low dosage of it for insomnia and a higher one for depression. And yet another antidepressant, mirtazapine – which goes by the brand name Remeron – “has more of a histamine effect,” Christiansen says. “In a low dose, it makes people quite sleepy and can help people go to sleep. In higher doses, it actually becomes less sedating and a bit more activating.”
“A number of antidepressant medications are used to treat pain,” Diaz says, and are prescribed to patients with conditions including – but not limited to – headaches, chronic nerve pain and fibromyalgia, a disorder that causes muscle aches and tiredness. These medications include tricyclic antidepressants, which are chemical compounds used as antidepressants; selective serotonin norepinephrine reuptake inhibitors, which are a class of medicines that affect brain chemicals called serotonin and norepinephrine; and selective serotonin reuptake inhibitors, which regulate serotonin.
In 2010, the FDA approved one SNRI called duloxetine – brand name, Cymbalta – to be used to treat pain. But doctors have been using off-label antidepressants to treat pain for decades, Christiansen says.
Doctors don’t know why, exactly, antidepressants help the body feel relief from pain.
However, Christiansen says, “There’s some degree of an emotional component to pain. For example, if you’re feeling really good, you might not notice your finger’s cut. If you’re feeling more morose, it’s probably going to be bit more of a stronger sensation. That might be one way of looking at how the antidepressants play a role – they’re modulating, in some capacity, the way that your brain is actually processing the information.”