To the Editor: The article by Dr. Onyike et al. detailing the case of mania caused by pegylated IFN-α with ribavirin was a thorough review. It will be particularly useful for those who have not yet treated a patient experiencing these adverse psychiatric consequences from IFN-α.

However, I saw one recommendation in the review that I disagree with. In the appendix of the article, there was a table with treatment recommendations for a patient experiencing manic symptoms from IFN-α treatment. I noticed that gabapentin was one of the agents. Although there have been numerous case reports and open-label studies citing the usefulness of gabapentin for mania, a double-blind, placebo-controlled trial is the gold standard and the ultimate "litmus test." In 2000, Pande and colleagues (1) observed no difference between gabapentin and placebo for the adjunctive treatment of mania. If this trial failed to show an effect as an adjunct, I don’t see how gabapentin could be used as monotherapy either.

When considering that the National Public Radio network has broadcast to the general public four times in 2003 alone regarding a lawsuit involving gabapentin for bipolar disorder (2), I believe it is inadvisable to use this agent for mania—medication-induced or not.