Patterns of prescribing antiepileptic drugs for bipolar disorder

Off-label use of medications is the subject of great debate. Prescribing is influenced by a number of factors, including peer recommendations, pharmaceutical industry marketing, and evidence-based drug effectiveness reports. Understanding prescribing patterns for a particular drug class can inform efforts to provide fair and balanced information to prescribers. This study investigated four dimensions of psychiatrists' prescribing practices for antiepileptic drugs (AEDs) for bipolar disorder: 1) psychiatrists' current use of AEDs, 2) their actual and preferred sources of information on AEDs, 3) their knowledge about the Neurontin lawsuit, and 4) their reactions to sample marketing campaign materials, including key messages from an evidence-based report on the topic. Qualitative methods, including telephone and in-person focus groups and in-depth interviews, were used to explore these dimensions. We found that psychiatrists prescribe AEDs for off-label use, but that they are not using gabapentin as a primary treatment for bipolar disorder. The psychiatrists also reported that they obtained their information about AEDs from professional journals, colleagues, and pharmaceutical representatives. The psychiatrists were asked to review a set of four key messages derived from an evidence-based report on the use of AEDs to treat bipolar disorder. They had misconceptions about the efficacy of the draft messages as they were written, stating that they were oversimplified and erroneous. The messages were revised based on the participants' feedback. However, the core findings from the evidence-based report remained unchanged. Recommendations for developing and disseminating messages and materials for a future corrective marketing campaign to provide fair and balanced information to physicians about gabapentin and other AEDs are discussed.