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Off-label indications for antidepressants in primary care: descriptive study of prescriptions from an indication based electronic prescribing system

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j603 (Published 21 February 2017) Cite this as: BMJ 2017;356:j603

What do the authors mean by "strong evidence"?

It is my understanding that the jury is out on antidepressants. In other words, there is not even strong evidence for "On-Label" prescribing. 1

Therefore, I would like to understand what the authors mean by "strong evidence" (2) for off-label prescribing and how I can translate their understanding of strong evidence with, for example, a Cates diagram or absolute risk reduction numbers for patients.

In the interest of my patients, I would need to know for example on what kind of studies their "strong evidence" is based, what number and type of patients and how long did these studies run for?

Or is the "strong evidence" based on the DRUGDEX compendium, as indicated in table 1, if that is the case, that should be mentioned as conflict of interest? (3)

1 Wong J, Motulsky A, Abrahamowicz M, McGill J, Eguale T, Buckeridge DL,Tamblyn R.Off-label indications for antidepressants in primary care: descriptive study of prescriptions from an indication based electronic prescribing system BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j603

2 Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J., & Johnson, B. T. (2008). Initial severity and antidepressant benefits: a meta-analysis of data submitted to the food and drug administration, PLoS Medicine, 5(2), e45 EP http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.00...

3 https://micromedex.com/about-micromedex

Competing interests: No competing interests

27 February 2017
Wouter Havinga
locum GP
NHS
GL6 6JL