Purpose: To understand the extent of off-label prescribing among paediatrics, the study assessed the prescribing patterns of antidepressants in ambulatory settings in the USA.

Methods: A cross-sectional analysis was conducted using the National Ambulatory Medical Care Survey from 2000 to 2006.  The prevalence of off-label prescribing of antidepressants was estimated, and predictive factors were evaluated.

Participants: Children and adolescents aged 6-18 years to private physicians' offices.

Main Outcome Measures: Prevalence of antidepressant prescriptions including FDA and non-FDA-approved indications, types of antidepressants prescribed and factors associated with off-label prescribing.

Results: Our study population made 18,646 visits to private physicians' offices, representing about 667 million weighted visits during the study period.  The mean age of the patients was 12.2 years (SD = 3.7), and majority of the visits were made by White people (73.1%).  Of all visits, 3.7% (95% CI, 3.2% to 4.2%) were associated with antidepressants.  The most prevalent form of antidepressants prescribed were selective serotonin reuptake inhibitors (63.7%).  Only 9.2% of the visits were associated with FDA-approved indications.  Visits made to paediatricians (adjusted OR = 2.4; 95% CI, 1.1 to 5.1), family physicians and other offices (adjusted OR = 1.9; 95% CI, 1.2 to 3.1) were more likely to be associated with off-label prescribing as compared with visits to a psychiatrist's office.

Conclusions: The study observed a very high prevalence of off-label antidepressant prescribing patterns among children and adolescents in US ambulatory care settings. inated efforts should be placed to evaluate the potential reasons and ramifications of antidepressant off-label prescribing to guard patients' safety.

One of the authors is with Johnson and Johnson and Janssen Pharmaceutical Services.