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
“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.”
Pain
“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.”
“To my knowledge they’re not really affecting the nerve receptors at the source of the discomfort or pain,” Christiansen adds. “They’re really modulating the way the brain processes it.”
Smoking
Wellbutrin — also known by its generic name, bupropion — is a common norepinephrine and dopamine reuptake inhibitor. But it’s also marketed as Zyban to help people stop smoking, and is FDA-approved for that purpose.
“Smoking is a high-frequency behavior, coupled with oral and [sensory] gratification,” says David Farb, professor and chair of Boston University School of Medicine’s Department of Pharmacology & Experimental Therapeutics. “The aroma of the burning tobacco is rewarding to those people who enjoy it. Coupled with the physiological effects of the nicotine in the blood, it’s a very highly rewarding behavior.”
According to doctors, it’s thought that Zyban affects the brain’s reward circuits and decreases one’s desire to smoke. Also, Farb says, smoking might be used as a way of treating one’s own anxiety. By treating someone’s underlying worries with medication, he or she might feel less compelled to light up.
Irritable Bowel Syndrome and Bedwetting
“Tricyclic antidepressants affect multiple receptors throughout the central nervous system and GI system,” Christiansen says. Therefore, medicines such as amitriptyline (Elavil) can be used to treat irritable bowel syndrome.
Another TCA, imipramine, can be also used for bedwetting — although Christiansen says it’s an older medication, and it’s probably prescribed less these days than it used to be. It’s unclear why TCAs help with bedwetting, but doctors suspect they might affect the bladder muscles.
Learning and Memory
According to Farb, SSRIs can be used to treat certain learning disabilities that are related to learning in the brain’s upper right hemisphere — the area associated with visuospatial skills, direction and attention.
“In particular, they can be remarkable in some children, in young adults and probably in adults,” Farb says.
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6 Little-Known Uses for Antidepressants originally appeared on usnews.com
