Date Available
5-5-2027
Year of Publication
2025
Document Type
Graduate Capstone Project
Degree Name
Master of Public Health (M.P.H.)
College
Public Health
Department/School/Program
Public Health
Faculty
Dr. Anna Hoover
Committee Member
Dr. Erin Abner
Faculty
Dr. Steven Browning
Faculty
Dr. Daniela Moga
Abstract
Background: Off-label use of antidepressant medications is common, yet little is known about the extent to which such use can be explained by conditions other than depression. Even less is known about how cognitive function might influence prescribing patterns. This study investigates the prevalence of off-label antidepressant use among adults, assesses whether such use corresponds with known off-label conditions, and explores whether cognitive status affects these patterns.
Methods: A retrospective cross-sectional study was conducted using data from the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set Version 3.0, comprising participants aged 26-105 from Alzheimer’s Disease Research Centers across the U.S. Participants reporting antidepressant use without any indication of depression were classified as engaging in off-label use. Conditions commonly associated with off-label antidepressant prescriptions (e.g., anxiety, insomnia, diabetes, substance use disorder, alcohol use disorder, smoking, and bipolar disorder) were assessed. Participants were categorized by cognitive status—normal, some impairment, and dementia—and multivariable logistic regression was used to identify demographic and clinical predictors of unexplained antidepressant use.
Results: Of the 3,478 antidepressant users, 1,084 (31.2%) reported no depression diagnosis, which indicates off-label use. Among these, 79% did not report any of the evaluated off-label conditions. This pattern persisted across all cognitive groups, including 81.2% with normal cognition, 70.7% with some impairment, and 81.7% with dementia. SSRIs were the most commonly prescribed antidepressants across all groups. No significant demographic or cognitive predictors of unexplained use were identified in regression models.
Discussion: A substantial proportion of adults [prescribed antidepressants do not report either depression or common off-label conditions, raising concerns about unrecognized drivers of antidepressant use. While SSRIs were most commonly prescribed, the absence of identifiable indications in most cases, including among cognitively impaired individuals, suggests a need for closer scrutiny of prescribing practices. These findings underscore the importance of examining medication use in cognitively vulnerable populations and call for further research using more representative samples to understand potential risks and improve clinical decision-making.
Recommended Citation
Fursman, Faith, "The Intersection of Antidepressant Use, Health Conditions, and Cognitive Function in Alzheimer's Disease Research Center Participants" (2025). Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.). 479.
https://uknowledge.uky.edu/cph_etds/479
