Responses 140

Rocio R Response 1

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.

Zhaofei L Response 2

• Would you prescribe the gabapentin? Why or why not?

Based on the information provided, I will not prescribe gabapentin immediately, but I would like to find out why the patient is taking it from the ordering physician. First, this is a new patient; a thorough medical and psychiatric history and examination must be performed before any planned treatment, including medication prescription. Secondly, the patient was not sure why he took gabapentin, which makes prescribing the medication very risky. For example, the patient could be harmed by taking the wrong medication or taking too much of the medication. In some situations, the medication can even be contraindicated. Therefore, healthcare providers should never prescribe medications without an appropriate patient exam and medical reasons. To avoid issues and confusion about patients’ current medications, Boland (2021, p. 7) suggested that the patient should be asked to bring all medications currently being taken, prescribed or not, over-the-counter preparations, vitamins, and herbs to the initial interview. Therefore, the PMHNP can review all of them to plan the treatment and adjust medications if needed.

• Should a PMHNP prescribe medications not intended for psychiatric use?

In some situations, it may be appropriate for a PMHNP to prescribe medications not intended for psychiatric use, such as the urgent need to prevent patient harm and the management of psychiatric medication side effects. Other than that, I believe a PMHNP should not prescribe medication not intended for psychiatric use. Even PMHNPs are not limited to prescribing only psychiatric medications; prescribing non-psychotropic medications is complicated by many factors. The patient’s primary care provider and other specialty providers may have already established their treatment plans for the medical conditions. Ordering medications may interfere with these treatment plans and cause discrepancies. In addition, PMHNPs prescribing medications not intended for psychiatric use may increase multimodal therapy. According to the Joint Commission (2020), multimodal therapy happens when more than one medication is prescribed for the same indication, which can cause severe safety issues for patients. In conclusion, when prescribing medication, the key is patient-centered care, clear roles between healthcare specialties, and effective communication.

• Does gabapentin have any psychiatric benefits?

Even though not approved by the U.S. Food and Drug Administration, gabapentin is commonly prescribed for anxiety and bipolar disorder. According to Stahl (2020, p. 331), gabapentin may reduce anxiety in a variety of disorders within a few weeks and may be effective in a subset of bipolar patients, in some patients who fail to respond to other mood stabilizers, or it may not work at all. Many patients have only a partial response where some symptoms are improved, but others persist or continue to wax and wane without stabilization of pain or mood. Other patients may be nonresponders, sometimes called treatment-resistant or treatment-refractory.