Racial-ethnic differences in off-label antidepressant use, by insurance type

Objective: The objective of this study was to examine whether and to what extent racial-ethnic differences exist in off-label use of antidepressant drugs by insurance type (Medicare, Medicaid, private coverage, and uninsured). Methods: Multiyear data (2000-2010) from Medical Expenditure Panel Surveys were used. Logistic and negative binomial regressions were used for the likelihood and frequency analyses, respectively. Results: The likelihood of filling prescriptions for off-label use of antidepressants was greater among blacks than among whites in all insurance groups (Medicare [N=6,470], adjusted odds ratio [AOR]=1.68; Medicaid [N=3,076], AOR=1.76; private coverage [N=9,918], AOR=2.10; and uninsured [N=1,826], AOR=1.88). Only in the uninsured group were Hispanicsmore likely thanwhites to use antidepressants off label (AOR=1.58). Among off-label antidepressant users, blacks and Hispanics with private coverage filled significantly fewer off-label antidepressant prescriptions than whites (blacks, incidence rate ratio [IRR]=.81; Hispanics, IRR=.88). Conclusions: Off-label use of antidepressants was more likely among blacks than among whites in all insurance groups; however, once whites initiated off-label use of antidepressants, they tended to fill off-label antidepressant prescriptions more frequently than blacks or Hispanics. Because off-label use may be inappropriate, clinical and policy efforts should aim to reduce off-label antidepressant use, with particular attention to racial-ethnic differences.