{"type":"rich","version":"1.0","title":"How to Prescribe Off-Label With Henry Nasrallah, MD","description":"Joseph F. Goldberg, MD, in this installment of \"Brain Trust: Conversations in Psychopharmacology,\" sits down with Henry Nasrallah, MD, to discuss off-label prescribing and polypharmacy.\n\nNasrallah bases the discussion off his landmark analysis that demonstrated 88% of DSM psychiatric diagnoses have no US Food and Drug Administration (FDA)-approved pharmacotherapy, leaving clinicians with no choice but to prescribe off-label for many of the patients they encounter. He argues that the FDA's diagnosis-centric approval framework, rather than a symptom- or circuit-based model, is a primary driver of this gap, noting that a shift toward symptom-level indications could render irrelevant much of current off-label practice.\n\nBoth clinicians emphasize that off-label prescribing, when rationale-based and neuroscientifically informed, constitutes responsible clinical care rather than reckless deviation. Nasrallah describes examples like using valproate for impulsive aggression in traumatic brain injury, clozapine augmentation for treatment-resistant suicidality, and high-dose modafinil for refractory depression—each grounded in mechanistic reasoning. Goldberg observes that \"off-label practices are legitimate…good for patients and save a lot of lives,\" while cautioning that prescribers must understand what a drug does in the brain, not merely follow or ignore labeling.\n\nThe conversation also addresses the transdiagnostic model, polypharmacy, insurance barriers to off-label coverage, and the underutilization of clozapine. Nasrallah concludes by characterizing off-label discovery as \"a creative process, the cutting edge of scientific advances,\" urging clinicians to publish case reports and share serendipitous findings to catalyze future trials.","author_name":"Brain Trust: Conversations in Psychopharmacology","author_url":"https://audioboom.com/channels/5169832-brain-trust-conversations-in-psychopharmacology","provider_name":"Audioboom","provider_url":"https://audioboom.com","width":480,"height":95,"thumbnail_url":"https://audioboom.com/i/43675319/600x600/c","thumbnail_width":600,"thumbnail_height":600,"html":""}