In fiscal year 2007 nearly 280,000 patients in the Department of Veterans Affairs (VA) health care system received a prescription for an antipsychotic. In a study reported in this month's issue, Douglas L. Leslie, Ph.D., and colleagues found that 60% of these patients had no record of a diagnosis for which these medications are approved. Antipsychotics are the cornerstone of effective treatment of schizophrenia, and most have been approved for treating bipolar disorder. One—aripiprazole—was approved in late 2007 for adjunctive treatment of major depression. However, after a drug has received approval, clinicians are free to prescribe it for other conditions as they see fit. The VA researchers found that patients with posttraumatic stress disorder accounted for the largest percentage (42%) of off-label prescriptions for antipsychotics, followed by minor depression (40%), major depression (23%), and anxiety disorder (20%). "Given that these drugs are expensive, have potentially severe side effects, and have limited evidence supporting their effectiveness for off-label usage, they should be used with greater caution," the authors conclude (page 1175).