Psychiatric medications receive extensive study. Medications that have been approved for conditions such as sleep, anxiety, epilepsy, bipolar disorder, and many others, are typically are only approved when they have undergone extensive testing and rigorous study. The FDA rarely rushes these medications, and neither do the companies that create them.
But what is fascinating about the human body is that the hormones, neurotransmitters, nerves, and other internal structures do not have only one function. For example, serotonin – the neurotransmitter responsible for pleasure and happiness in the brain – is also responsible for moving food down the intestine, and increasing feelings of fullness. It’s why SSRIs (medications that increase serotonin levels) can also reduce hunger, even though they’re not specifically designed for that purpose.
When a medication is studied for one function, but can also have an effect that may help with a different condition, some psychiatrists may choose to prescribe that medication despite not specifically being approved for that purpose. This is known as using a medication “off label” – that is, for a purpose other than what it was intended to be used for.
Is Off Label Usage of Medication Controversial?
Using medications “off label” is not considered controversial at all in the field of medicine. In fact, it is standard practice. Many medications that we use today were initially designed to treat something else. Doctors and psychiatrists everywhere use medications off label often, prescribing them when a patient has a medical history that indicates they will be a good option.
Why Are Medications Used Off Label? Can’t it Be Dangerous?
It’s important to distinguish between off label use and reckless use. Remember how earlier we said that medications undergo extensive testing. That testing is so extensive, that it is also profoundly expensive. When research finds that a medication has a positive benefit for a condition other than its initial purpose, the company may not want to re-invest in its research and allow doctors to decide if it is something they want to prescribe.
Keep in mind, however, that these medications are still extensively researched. No reputable psychiatrist ever prescribes a medication without a certainty that the medication will have a desired effect. Off label medications still receive considerable research, but it may not be for regulatory approval and may not be conducted by the pharmaceutical company. It may instead be conducted in universities, or by other scientists, or in some other manner.
What Are Some Examples of Off Label Psychiatric Medications?
Many mental health medications are used off label, originally studied for other conditions – some related to mental health, some not. While we are not advocating for any specific medication, as we have to review your entire health history, some examples of off label medications that are used in the psychiatric world include:
- Gabapentin (Neurontin) – Designed to treat epilepsy and neuropathic pain, gabapentin is sometimes prescribed off-label for conditions such as anxiety disorders, bipolar disorder, and insomnia.
- Pregabalin (Lyrica) – Developed for neuropathic pain and as an anticonvulsant, pregabalin is sometimes prescribed off-label for conditions like generalized anxiety disorder, social anxiety disorder, and fibromyalgia.
- Topiramate (Topamax) – Approved as an antiepileptic medication and for migraine prevention, topiramate is sometimes prescribed off-label for conditions like bipolar disorder, binge eating disorder, and alcohol use disorder.
- Hydroxyzine (Vistaril, Atarax) – Although primarily used as an antihistamine, hydroxyzine is sometimes prescribed off-label for its anxiolytic properties, particularly for generalized anxiety disorder and insomnia.
Sometimes, a medication is approved for one mental health condition, but prescribed for related conditions. For example, Buspirone (buspar) has only technically been approved for generalized anxiety disorder, but some psychiatrists may recommend it for similar conditions like social anxiety disorder and panic disorder. Even though these are all anxiety-related conditions, this is still considered “off label” use.
When is Off Label the Right Choice?
There is no way to recommend or not recommend off label medications without an extensive look at your medical history. Sometimes, the reason to prescribe off-label medications is because others might not have worked, or might have interacted with your other medicines. Sometimes, the reason to prescribe a medication off label is because it is well tolerated and the psychiatrist thinks it will be a smart choice for your condition and symptoms.
Off label is not inherently good or bad. It is just another option that our psychiatrists at Aware Behavioral Health may consider to help you treat your mental health struggles. Get psychiatric care for your mental health by contacting Aware Behavioral Health, today.