CNS Spectrums' Editor-in-Chief Defends Off-Label Prescribing

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World-Renowned Psychiatry Professor and Clinician Dr. Stephen Stahl Defends Off-Label Prescribing.

Prominent psychiatrist, author, and editor-in-chief of the neuropsychiatric journal, CNS Spectrums, Dr. Stephen M. Stahl vigorously defends off-label drug prescribing for psychotropic drugs in the new CNS Spectrums article feature “CNS Brainstorms”, now part of the peer-reviewed journal.

The first “Brainstorms” article type was published in 2000 in another journal within the psychiatric literature, and it quickly established itself as one of the most popular, widely read, highly cited, and regularly downloaded articles in the field. Now adapted and integrated into CNS Spectrums, Stahl uses this forum to jump into the current debate on off-label drug prescribing.

In his defense (‘Off-label prescribing: best practice or malpractice?’) of using a U.S. Food and Drug Administration (FDA) approved medicine in a manner not covered by the drug’s official label, Stahl points out that this is necessary in an estimated 80% of psychiatric treatments as these complex and highly individual illnesses have no medicines specific to them.

The debate has recently been given new life by what Stahl calls “lawsuits, scandalous publicity and ‘eye-popping’ fines” against the off-label sellers in the pharmaceutical industry. Now he fears confusion is growing, making the public believe that sellers and prescribers are held to the same standard. Stahl says:

“Having one standard for all, sellers and doctors alike, is a seductive idea for those outside the profession who would seek to regulate it without understanding it. But should a doctor who is prescribing a drug for a patient with highly specific needs really be held to exactly the same rules as the salesperson responsible for selling the drug? This is medically absurd in a field where each patient’s needs are as individual as they are. Careful, educated, off-label prescription by an experienced professional is their only hope of controlling their illness.”

At the same time as defending a practice Dr. Stahl sees as utterly necessary and unavoidable, he also issues a warning to the medical profession to proceed with caution:

“As practitioners, we must robustly defend the practice of medicine on a patient-by-patient basis. At the same time, we need to hold ourselves to high standards, keeping better records, being ever-aware of the boundary between clinical practice and research and, crucially, educating the public and regulators about the art and intricacy of our brand of medicine. Treating minds is always going to be more complex than treating ears or legs or hearts, and we need people to understand this.”

Stahl points out that this need to protect the practice and educate the enforcers is becoming even more important as we enter the era of genetic markers, moving medicine in general, and mental health medicine in particular, ever more in the direction of individualized treatment:

“It would be a tragedy if, as we enter this exciting new era, we are so out of step with the forces that seek to regulate us, and they understand us so little, that we have to fight that battle. We should put all our energies into exploring the new possibilities in patient treatment that a combination of genetic markers and off-label practice offers us.”

CNS Spectrums (including “CNS Brainstorms”) is the Journal of the Neuroscience Education Institute and is published by Cambridge University Press.

The full paper is available at:


For further information or to arrange interviews please contact:

US Media:
Susan Soule, Journals Marketing Manager, Cambridge University Press, Americas:
Tel: 212-337-5019
Email: ssoule(at)cambridge(dot)org

UK Media:
Vicky Westmore, Communications Officer, Cambridge University Press
United Kingdom:
Tel: +44 (0)1223 326194
Email: press(at)cambridge(dot)org

About CNS Spectrums
The journal brings clinical research and information to 50,000 psychiatrists and neurologists. Launched in 1996, CNS Spectrums reaches more physicians than any other peer-reviewed neuropsychiatric journal in the world. The journal’s goal is to serve as a resource to psychiatrists and neurologists seeking to understand and treat disturbances of cognition, emotion, and behavior as a direct consequence of central nervous system disease, illness, or trauma.

About the Neuroscience Education Institute
Founded in 2000 by Dr. Stephen M. Stahl, the NEI provides interactive learning to mental health clinicians and neuroscientists. Through NEI's annual Psychopharmacology Congress, its web-based activities, and its online resources, NEI simplifies complex concepts to enhance understanding. NEI Members and Guests have access to this online resource focused on the essentials of psychopharmacology.

About Stephen M. Stahl
Dr Stephen M. Stahl is Adjunct Professor of Psychiatry at the University of California, San Diego and the author of the best-selling textbook Essential Psychopharmacology, now in its fourth edition, as well as the best-selling clinical manual, Essential Psychopharmacology Prescriber's Guide. Stahl is an internationally renowned clinician, researcher and teacher in psychiatry.

About Cambridge Journals
Cambridge University Press publishes over 300 peer-reviewed academic journals across a wide spread of subject areas, in print and online. Many of these journals are the leading academic publications in their fields and together they form one of the most valuable and comprehensive bodies of research available today.

About Cambridge University Press
Cambridge University Press is the publishing business of the University of Cambridge. Dedicated to excellence, its purpose is to further the University's objective of advancing knowledge, education, learning, and research.

Its extensive peer-reviewed publishing lists comprise 45,000 titles covering academic research, professional development, over 300 research journals, school-level education, English language teaching and bible publishing.

Playing a leading role in today’s international market place, Cambridge University Press has more than 50 offices around the globe, and distributes its products to nearly every country in the world.

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