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Reducing off-label prescribing in psychiatry

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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.

First, precision in diagnostic and therapeutic practice is hard to achieve because of low reliability and questionable validity of the major diagnostic groupings.13

Second, a wide gap persists between the number of people affected by mental disorders and the number who demand and receive care.4 In Australia, the continuing growth in demand for clinical services extends across all age groups for psychological as well as pharmacological interventions.5,