Initial Discussion questions : A new patient presents to your office for treatment of bipolar disorder. In his medical history, he reports that he takes gabapentin prescribed by his primary care provider, but he is not sure what he takes it for. He states he is almost out of his gabapentin and is asking you for a refill.
Consider the following questions in your initial post:
- Would you prescribe the gabapentin? Why or why not?
- Should a PMHNP prescribe medications not intended for psychiatric use?
- Does gabapentin have any psychiatric benefits?
Instructions for peer replies:
In your response posts, consider the position that your peer has stated regarding prescribing gabapentin. Also, include 2-3 questions that you could ask the patient to help determine if it is appropriate for a PMHNP to prescribe gabapentin?
Peer post #1: Rocio
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.
Peer Post #2: Monica
Based on the information, I would not prescribe Gabapentin without asking more questions. I would try to figure out what dosage of Gabapentin the patient is on and what the PCP’s intention was for prescribing It. I will ask the patient if they know the name of their PCP to see what the reason for prescribing Gabapentin was. According to Pollack et al. (1998), a dosage of 200-1800 mg/day improved patients’ anxiety symptoms significantly, especially in patients with a primary psychotic disorder. When patients are taking Gabapentin at higher doses, then Gabapentin is mainly prescribed for nerve pain. If Gabapentin were prescribed for anxiety and not nerve pain, then I will prescribe Gabapentin again if the patient states it is working for him.
PMHNPs should not prescribe medication not intended for psychiatric use because we must stick to our scope of practice, but there is no rule that they cannot because NPs have prescriptive authority. For example, if a PMHNP prescribes an antibiotic and the patient has an adverse effect from the antibiotic, then the PMHNP can potentially be liable for the patient.
According to (Martin & Gainer, 2022), Gabapentin does have sufficient evidence supporting that this medication can be used as a third-line treatment for social anxiety disorder and severe panic disorder. During clinical preceptorship, there was a patient who confirmed that Gabapentin was working for her anxiety symptoms.
