Journal of Psychiatric Practice Vol. 14, Suppl. 1 44 March 2008
Major advances have been made in the number and
types of medications for psychiatric illness. As the num-
ber of medications within a class increases, so does the
complexity of decision-making for the prescriber.
Because the demands and rigors of clinical practice do
not allow prescribers time to undertake their own
research or literature reviews on drug effectiveness,
they must often rely on other sources of information to
guide their choice of medication. Such choices are
informed by a number of sources, some evidence-based
and some not, including peer reviewed and other publi-
cations, participation in continuing medical education
(CME), computer-based clinical decision support sys-
tems, clinical practice guidelines, advertising, and con-
sultation with peers.
Unfortunately, certain information available to pre-
scribers has led to inappropriate use of various classes
of drugs. One case in point is the use of antiepileptic
drugs (AEDs) for bipolar disorder. Although approved in
1993 by the U.S. Food and Drug Administration (FDA)
only for adjunctive treatment of partial complex
seizures, the manufacturer of the AED gabapentin
(Neurontin) promoted its off-label use for treatment of
psychiatric disorders, including bipolar disorder, even
though its efficacy for psychiatric disorders had not
been demonstrated. A recent publication outlined the
tactics used in the industry promotion of gabapentin
Disseminating Findings from a Drug
Class Review: Using Best Practices to
Inform Prescription of Antiepileptic
Drugs for Bipolar Disorder
Evidence from drug class reviews is often not accessible to practicing clinicians nor is it presented in a way that
allows clinicians to use the information to guide treatment and prescribing decisions. Nevertheless, information
from such reviews can be very helpful to clinicians as they evaluate the “evidence” provided to them through
marketing strategies implemented, primarily, by the pharmaceutical industry and designed to influence their
prescribing behavior. Unfortunately, these marketing strategies can be used to promote the off-label use of drugs
that may not be efficacious. One example is the pharmaceutical marketing to promote off-label use of gabapentin
(Neurontin) for the treatment of bipolar disorder, the legality of which was later addressed in a major lawsuit by
the National Association of Attorneys General. We describe an effort to use counter-marketing strategies to com-
pete with those implemented by the pharmaceutical industry and to help clinicians, principally psychiatrists,
make use of available evidence to inform their prescription of antiepileptic drugs (AEDs) in the treatment of
bipolar disorder. A growing body of literature describes industry marketing practices designed to influence pre-
scriber behavior. This literature suggests that use of competing approaches involving the same underlying
strategies to deliver highly credible information from trusted sources can inform prescriber knowledge and pre-
scribing practice. We describe our use of existing evidence to develop accurate and convincing messages and
materials to be disseminated nationally to counter industry misinformation and promote evidence-based pre-
scription of AEDs. (Journal of Psychiatric Practice 2007;14(suppl 1):44–56)
KEY WORDS: bipolar disorder, antiepileptic drugs, gabapentin, marketing, dissemination
CATHY L. MELVIN, PHD, MPH
LEAH M. RANNEY, PhD
TIMOTHY S. CAREY, MD, MPH
W. DOUGLAS EVANS, PHD
AED DISSEMINATION PANEL
MELVIN, RANNEY, and CAREY: Cecil G. Sheps Center for
Health Services Research, The University of North Carolina at
Chapel Hill; EVANS: RTI International, Inc. Washington, DC.
The AED Dissemination Panel is composed of Cathy L. Melvin, PhD,
MPH, W. Douglas Evans, PhD, Gary Kreps, PhD, Thomas Linden,
MD, John Oldham, MD, MS, and Leah Ranney, PhD.
Copyright ©2008 Lippincott Williams & Wilkins Inc.
Please send correspondence and reprint requests to: Cathy L. Melvin,
PhD, MPH, The Cecil G. Sheps Center for Health Services Research,
The University of North Carolina at Chapel Hill, 725 Martin Luther
King Jr. Boulevard, CB#7590, Chapel Hill, NC 27599-7590.
cathy_melvin@unc.edu
Funded by a grant administered by a consortium of state attorneys
general.