Gabapentin for Anxiety: Bipolar Disorder Drug

Gabapentin for Anxiety

Gabapentin, a prescription drug used to treat mental illnesses of a common type, also helps with alcohol disorders.

The big question is, Does it work? What are the side effects? Let us shed some light on the above questions.

Gabapentin is an anticonvulsant prescription drug known by several brand names, including Neurontin, Gralise, Gabarone, and Fanatrex. FDA approved it in December 1993 for the following main uses.

• Controlling certain types of seizures in people who have epilepsy
• Relieving nerve pain (think: burning, stabbing, or aches) from shingles
• Calming restless legs syndrome
• But since it’s been available, gabapentin has also been used off-label in psychiatry to treat patients with treatment-resistant mood and anxiety disorders as well as alcohol-withdrawal and post-traumatic stress.
• It works by decreasing abnormal excitement in the brain for seizures and changing the way the body senses pain for nerve pain.
• Researchers don’t know exactly how it works for psychiatric conditions.

Treatment with Gabapentin: Important Things to be aware of Before Taking Gabapentin

Before start gabapentin therapy, one should have a thorough medical exam to rule out any medical issues.

This includes any urine or blood tests. Medical evaluations are crucial as gabapentin can provoke hormonal imbalances. Similar to any other drug, you should not take gabapentin if you’re responding allergically to it.

There are side effects—I will discuss this aspect later. However, a few of the most important things your doctor will want to know before prescribing gabapentin is if you have or have had any of the following:

• Diabetes
• Drug or alcohol addiction
• Kidney problems (or if you’re on dialysis)
• Liver or heart disease
• Lung disease (see the warning above on respiratory issues)
• Mood disorders, depression or bipolar; or if you’ve ever thought about suicide or attempted suicide
• Seizures (unless, of course, you’re taking it for seizures)

You should also know that not enough studies have been done to understand the exact risks of gabapentin if you’re pregnant or breastfeeding.

How Gabapentin Is in Use to Treat Anxiety Mood Disorders Such As Depression

Gabapentin isn’t usually prescribed to treat anxiety on its own. Often, it’s given to ease anxiety symptoms for people who also have depression or bipolar disorder.

(Anxiety is commonly comorbid with depression and bipolar.) The reason is that it may not be effective for just anxiety.

A closer look comparing seven different clinical studies on how successful gabapentin is for anxiety shows that gabapentin may be better than a placebo in treating generalized anxiety disorder (GAD) but not significantly better.

Results may be a tad more promising for social anxiety disorder.

The clinical studies for treating depression with gabapentin are also pretty inconclusive. No scientific studies confirm if it’s effective—either alone or as part of some other therapy.

Nevertheless, some anecdotal evidence is helpful, especially with patients who don’t seem to improve with more standard antidepressants.

Gabapentin Use In Treating Mixed Bipolar States

Specifically, can it avert future episodes of mania and depression? At the present moment, there is no valid evidence that gabapentin may help treat people who have bipolar disorder.

High-quality, randomized controlled studies proved that gabapentin was not effective.^1,2

Gabapentin and Alcohol Usage Disorder

Gabapentin can be beneficial in treating alcohol use disorder and withdrawal.

From 2004 to 2010, The Veterans Affairs Department performed a double-blind, placebo-controlled, randomized dose-ranging trial test of 150 men and women over 18 strugglings with alcohol dependence.³

The study’s outcome proved that gabapentin (particularly the 1800 mg dosage) effectively treated alcohol dependence and relapse-related symptoms, including insomnia, dysphoria, and cravings.

Side Effects of Gabapentin use

Like any medication, some side effects may occur. Few of these are more likely to happen at the start of taking the medication.

Common side effects:

• Dizziness
• Double Vision
• Fatigue
• Nystagmus (involuntary eye movement)
• Sleepiness
• Tremors
• Unsteadiness

Less common side effects:

• Abnormal stool (black and tarry)
• Chest pain
• Chills
• Cough
• Depression, irritability, or other mood or mental changes
• Fever
• Fatigue
• Memory loss
• Pain (or swelling) in the arms or legs
• Painful or difficult urination
• Shortness of breath
• Sore throat/swollen glands

Usual side effects for people with mental illness:

• Agitation
• Decreased libido
• Depersonalization
• Increased libido
• Mania
• Paranoia

Gabapentin Medication and Administration

Typically, your doctor will prescribe 300 mg per day, usually in the evening, to start.

Then dosage will be increased every three to five days. Some people will take 600 mg/day; others will increase to 3,600 mg/day—the maximum dose approved by the FDA.

If used as a mood stabilizer or anti-depressant, the dose is usually between 900 and 2,000 mg a day.

But, it can also be increased for better results. Some people notice an improvement in their symptoms about a week post starting treatment.

Others need about a month before they notice significant improvement.

Gabapentin has a half-life of about six hours, so it must be taken three to four times a day.

How To Discontinue use of Gabapentin

Like any psychotropic drug, you should ease off gabapentin gradually. There are some known withdrawal symptoms.

This mostly comes from people who take high doses of the drug and suddenly stop.

You should only abruptly discontinue this drug because of a serious side effect, and even then, it should be done with your doctor’s supervision and direction.

Gabapentin Overdose and Toxicity

It’s possible to overdose on gabapentin fatally. Reports of gabapentin being abused alone and with opioids prompted the FDA to release a warning statement (in December 2019) about the fatal risk of respiratory depression.

Signs of overdose include:

• Ataxia (decreased muscle coordination)
• Diarrhea
• Drooping eyelid
• Drowsiness and lethargy
• Double vision
• Excitation
• Hypoactivity
• Labored breathing
• Marked sedation
• Slurred speech

If you suspect an overdose, you need immediate medical treatment.

The only way to remove the drug is through kidney dialysis in the emergency room.

3 Most Common Questions About Gabapentin

1. 1. Is there a generic version of gabapentin available?
      Since its manufacturer no longer has patent protection on the drug, generic versions are on the market. They include Neurontin, Gralise, Gabarone, and Fanatrex.
   2. How much does gabapentin cost?
      According to GoodRx.com, generic Gabapentin can cost between $7-$27 for ninety 100mg or 300mg capsules and between $14-$53 for ninety 400mg capsules.
   3. What is the difference between gabapentin and other mood-stabilizing medications?
      This is a trick question. Technically, even though we hear the term “mood stabilizer” quite often, especially in the context of bipolar disorder, the FDA doesn’t officially recognize the term.

Not only that, but even researchers and psychiatrists can’t come with a definition everyone agrees on. That said, lithium (probably the drug anyone with bipolar disorder is most familiar with) has significant differences from gabapentin.

Lithium is in a class called bipolar disorder agents. Gabapentin is in a class called anticonvulsants.

Their chemical structures are not the same, and they work differently in the body. In addition to being used for bipolar, both have also been used for epilepsy.

 

DISCLAIMER: The information contained in this article should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider.

This article mentions FDA-approved drugs and available at the time of publication and may not include all possible drug interactions or all FDA warnings or alerts.

The author of this page explicitly does not endorse this drug or any specific treatment method.

If you have health questions or concerns about interactions, please check with your physician or go to the FDA site for a comprehensive list of warnings.

Warning: The Food and Drug Administration issued a serious warning about gabapentin in 2019.

According to the FDA, breathing difficulties may occur in patients who have underlying respiratory problems (or in the elderly) when gabapentin (Neurontin, Gralise, Horizant) or pregabalin (Lyrica, Lyrica CR) is taken with other medicines that depress the central nervous system.

Conclusion

• There is evidence of risk with gabapentinoids alone in otherwise healthy people, too, though this evidence is not as strong and is still being monitored.
• Additionally, note that there are not many comprehensive studies that look at Gabapentin as a way to treat anxiety, mood disorders, or tardive dyskinesia (uncontrollable movements).
• As with any medication, always talk to your health care professional if you have any questions or concerns.

References

• FDA
• Pande AC, Crockatt JG, Janney CA, Werth JL, Tsaroucha G. Gabapentin in bipolar disorder: a placebo-controlled trial of adjunctive therapy. Gabapentin Bipolar Disorder Study Group. Bipolar Disord. 2000 Sep;2(3 Pt 2):249-55. DOI: 10.1034/j.1399-5618.2000.20305.x. PMID: 11249802.  Accessed October 22, 2020.
• Frye MA, Ketter TA, Kimbrell TA, Dunn RT, Speer AM, Osuch EA, Luckenbaugh DA, Cora-Ocatelli G, Leverich GS, Post RM. A placebo-controlled study of lamotrigine and gabapentin monotherapy in refractory mood disorders. J Clin Psychopharmacol. 2000 Dec;20(6):607-14. DOI: 10.1097/00004714-200012000-00004. PMID: 11106131. Accessed October 22, 2020.
• Mason BJ, Quello S, Goodell V, Shadan F, Kyle M, Begovic A. Gabapentin treatment for alcohol dependence: a randomized clinical trial. JAMA Intern Med. 2014;174(1):70-77. doi:10.1001/jamainternmed.2013.11950  Accessed October 22, 2020.