Off-label prescription of antiepileptic drugs in psychiatric inpatients

Off-label prescription of antiepileptic drugs (AEDs) is highly frequent in daily clinical practice. Most of these drugs have multiple mechanisms of action, which can explain their efficacy in the treatment of various non-epileptic central nervous system (CNS) disorders, both in neurological and psychiatric conditions.

The objective of this study was to analyze the use of AEDs in patients admitted to psychiatric hospital.

Clinical records of 205 patients were retrospectively reviewed to collect the following variables: demographic data, clinical diagnosis, associated comorbidities, and pharmacological treatments.

Antiepileptic drugs were prescribed to 43.9% of the patients (and 7.31% had more than one AED indicated). Off-label prescription was used in 65.55% of cases, and 10.00% of patients had dual prescriptions (co-occurrence of on-label and off-label indications). The most frequent diagnoses associated with off-label use were schizophrenia (33,33%), intellectual disability without epilepsy (31,11%), and psychosis associated with problematic substance use (17,78%). Valproic acid was the most frequently prescribed off-label drug (p<0.0001).

Despite emerging as promising options, it is essential to conduct further research to clarify the risks and benefits of using these drugs in the field of psychiatry.