Can Gabapentin be Used for Anxiety, Depression, and Bipolar Disorder ?

Gabapentin is an anticonvulsant prescription drug that goes by several brand names including, Neurontin, Gralise, Gabarone, and Fanatrex.

It was approved by the FDA in December 1993 for the following main uses.

    1. Controlling certain types of seizures in people who have epilepsy
    2. Relieving nerve pain (think: burning, stabbing, or aches) from shingles
    3. 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. (*Note: Some states have recently classified gabapentin as a controlled substance due to the potential for it to be abused and contribute to death from overdose.)

Treatment with Gabapentin: Important Things to Know Before Taking Gabapentin

Before you start gabapentin therapy, you should have a thorough medical exam to rule out any medical issues. This includes any blood or urine tests. Medical evaluations are important as gabapentin can induce hormonal imbalances. Like any other drug, you should not take gabapentin if you’re allergic to it.

There are side effects—more on that in a minute. But a few of the most important things your doctor will want to find out 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 Used to Treat Anxiety Mood Disorders Like Depression

Gabapentin isn’t usually used to treat anxiety alone. More often, it’s given to ease anxiety symptoms for someone who also has depression or bipolar disorder. (Anxiety is common comorbid with depression and bipolar.) The reason is that it may not be effective for just anxiety. A close look comparing seven different clinical trials on how successful gabapentin is for anxiety shows that gabapentin may be better than a placebo to treat generalized anxiety disorder (GAD), but not much better. Results may be slightly more promising for social anxiety disorder.

The clinical trials for treating depression with gabapentin are also pretty lackluster. To date, there are no scientific studies showing it’s effective—either on its own or as part of some other therapy. Still, there is some anecdotal evidence that it’s helpful, especially with patients who don’t seem to improve with more standard antidepressants.

How Gabapentin Is Used to Treat Mixed Bipolar States

More specifically, can it prevent future episodes of mania and depression? Right now, there is no good evidence that gabapentin can be used for treating people with bipolar disorder. High-quality, randomized controlled studies found that gabapentin was not effective.1,2

Gabapentin and Alcohol Use Disorder

Gabapentin may be helpful in treating alcohol use disorder and withdrawal. Between 2004 and 2010, The Veterans Affairs Department conducted a double-blind, placebo-controlled, randomized dose-ranging trial of 150 men and women over 18, struggling with alcohol dependence.3 The results of the study showed that gabapentin (particularly the 1800 mg dosage) was effective in safely treating alcohol dependence and relapse-related symptoms including insomnia, dysphoria, and cravings.

How many Health conditions does Gabapentin can treat ?

Gabapentin is an anti-epileptic medication, also called an anticonvulsant.

It affects chemicals and nerves in the body that are involved in the cause of seizures and some types of pain. Gabapentin is used in adults to treat nerve pain caused by herpes virus or shingles (herpes zoster).

The Horizant brand of gabapentin is also used to treat restless legs syndrome (RLS).The Neurontin brand of gabapentin is also used to treatseizures in adults and children who are at least 3 years old.

Gabapentin is also be used to treat following health conditions:

  • Alcohol Withdrawal
  • Anxiety
  • Benign Essential Tremor
  • Bipolar Disorder
  • Burning Mouth Syndrome
  • Cluster-Tic Syndrome
  • Cough
  • Diabetic Peripheral Neuropathy
  • Epilepsy
  • Erythromelalgia
  • Fibromyalgia
  • Hiccups
  • Hot Flashes
  • Hyperhidrosis
  • Insomnia
  • Lhermitte’s Sign
  • Migraine
  • Nausea/Vomiting, Chemotherapy Induced
  • Neuropathic Pain
  • Occipital Neuralgia
  • Pain
  • Periodic Limb Movement Disorder
  • Peripheral Neuropathy
  • Postherpetic Neuralgia
  • Postmenopausal Symptoms
  • Pruritus
  • Pudendal Neuralgia
  • Reflex Sympathetic Dystrophy Syndrome
  • Restless Legs Syndrome
  • Small Fiber Neuropathy
  • Spondylolisthesis
  • Syringomyelia
  • Transverse Myelitis
  • Trigeminal Neuralgia
  • Vulvodynia
Gabapentin off-label usage
Gabapentin off-label usage

One of Gabapentin “off-label” usage is for migraine prevention and treatment, including migraines with or without aura, vestibular migraines. It can reduce the frequency of headaches, pain intensity, and the use of symptomatic medications. Gabapentin is a good preventive therapy for migraines refractory to standard medications.

The chemical structure of gabapentin is related that of gamma-aminobutyric acid (GABA) which is a neurotransmitter in the brain. The exact mechanism as to how gabapentin controls epilepsy and relieves pain is unknown, but it probably acts like the neurotransmitter GABA.

The effective dose of gabapentin varies greatly. Some persons need only 200-300 mg a day whereas others may need 3000 mg or more a day. It may take several weeks to become effective, so it is important to stay on it for an adequate length of time.

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Gabapentin is a commonly used drug

Gabapentin remains a widespread and popular drug.

In 2016, it was the 10th most prescribed medication in the United States, with 64 million prescriptions.

As use of a drug grows, so does the unpredictability of side effects and potential for misuse.

“Once released as an approved drug, the number of people being prescribed the drug jumps substantially (tens of thousands to millions), and there is much more variability in the patient population and less control on how the drug is actually being taken,” said Bilsky.

A study from 2016 found that gabapentin misuse was low among the general population at just 1 percent. But that jumped to between 15 and 22 percent among people who misuse opioids.

“With decreasing availability of commonly abused prescription opioids, it has been suggested that nonmedical users of prescription opioids are substituting other licit and illicit drugs for abuse,” wrote the authors of a 2015 article on gabapentin misuse.

Gabapentin isn’t the only “safe” pain medication to show up on the radar of doctors and lawmakers in recent months, either.

As Healthline previously reported, Imodium — an over-the-counter anti-diarrheal drug — has also seen a surge in misuse. So much so that the U.S. Food and Drug Administration announced a plan to help cut down on its misuse potential.

Neither gabapentin nor Imodium is particularly good at getting someone high, so reasons for misuse are likely associated with cost and availability.

“It is hard to say what drives the person who suffers from a substance use disorder to switch between drugs and drug classes,” said Bilsky. “The current misuse of gabapentin may be another version of combining drugs to try and maximize the high.”

Editor’s note: This article was originally reported by Gigen Mammoser on April 9, 2018. Its current publication date reflects an update, which includes a medical review by Zara Risoldi Cochrane, PharmD, MS, FASCP.