Description
Oscar Anthony Tan
Bipolar disorder (BD) is a chronic mental health condition characterized by chronically occurring episodes of mania or hypomania alternating with depression. Treatment involves pharmacotherapy and psychosocial interventions, as well as management of other comorbid psychiatric and chronic medical conditions (Jain & Mitra, 2022).
Prescribing Gabapentin
Based on the case presented, the new patient came to the clinic for the treatment of his bipolar disorder and is asking for a refill for his gabapentin which was prescribed to him by his primary care provider. Given that the patient is not sure what he takes it for, I will not prescribe the patient gabapentin as it is important to gather more information about his medical history, current symptoms, and any previous psychiatric or neurological evaluations before prescribing the medication. There is also minimal evidence of its efficacy to support the use of gabapentin in the treatment of bipolar disorder (Hong et al., 2022). Therefore, it is necessary to be cautious to ensure the patient’s safety and well-being. If the patient’s symptoms align with a condition that gabapentin can effectively treat, and if the benefits outweigh the risks, I might consider prescribing or continuing gabapentin. However, if there’s no clear indication for its use or if there are better-suited alternatives available, I would look into other treatment options. For instance, if the medication is used as an off-label for his anxiety diagnosis and if this was possible to be confirmed, then I would refill enough of the medication to carry over to a follow-up appointment with the provider originally prescribing this medication.
Psychiatric Benefits of Gabapentin
Gabapentin has been reported to show efficacy as an adjunctive treatment medication, rather than as a monotherapy. There is evidence that supports its effectiveness as a treatment for alcohol withdrawal and alcohol use disorder, managing the individual’s alcohol cravings to establish sobriety (Martin & Gainer, 2022). It is also been reported to be considered as a third-line treatment option for social anxiety disorder and severe panic disorder.
Prescribing Medications Not Intended for Psychiatric Use
PMHNPs should not prescribe medications not intended for psychiatric use because their competency and skill set are primarily focused on mental health care. PMHNPS must always practice within the scope of their licensure and clinical expertise to ensure the patient’s safety and overall well-being. They may, however, refer the patients to a primary care provider for a consultation about their pharmacological treatment plans.
Rocio Reyes Echemendia
As a PMHNP, my decision to prescribe gabapentin would depend on the patient’s presenting symptoms and whether gabapentin is appropriate for their condition. According to Martin & Gainer (2022), the evidence does not support the use of gabapentin for bipolar disorder. In addition, PMHNPs are trained to assess, diagnose, and treat psychiatric disorders, but they can also prescribe medications for off-label use when clinically appropriate. Gabapentin, for example, is primarily indicated for the treatment of epilepsy and neuropathic pain but can be prescribed off-label for various psychiatric conditions (Martin & Gainer, 2022). Gabapentin can be used for the treatment of alcohol withdrawal and alcohol use disorder (Martin & Gainer, 2022). There is also clinical evidence that supports its use as a third-line treatment for social anxiety disorder and severe panic disorder (Martin & Gainer, 2022). Furthermore, gabapentin has been shown to have psychiatric benefits in managing certain symptoms, such as anxiety or insomnia (Martin & Gainer, 2022). Additionally, the efficacy of gabapentin has been demonstrated for alcohol dependence, both as monotherapy and adjunctive therapy (Martin & Gainer, 2022). Finally, there is sufficient evidence to consider the use of gabapentin for social anxiety disorder and, potentially, severe panic disorder after other treatment options have failed (Martin & Gainer, 2022).
In summary, prescribing gabapentin for a patient with bipolar disorder requires careful consideration of the patient’s symptoms, medical history, and treatment goals. As a PMHNP, I would not refill his gabapentin prescription since it is ineffective for bipolar disorder. While gabapentin may have some psychiatric benefits and can be prescribed off-label when appropriate, it’s essential to assess its suitability on a case-by-case basis and to discuss potential risks and benefits with the patient before making a prescribing decision.
