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.

Gabapentin for Fibromyalgia

Research suggests that people with fibromyalgia have too much glutamate in certain parts of their brain, so gabapentin has long been prescribed for it. But is it effective? Research is mixed.

Two reviews of the evidence disagree. One released in 2016 found that gabapentin is an effective fibromyalgia treatment,3 while another, published in 2017,4 reported only low-quality evidence.

In studies comparing gabapentin with pregabalin (Lyrica), including one published in The Journal of the American Medical Association, pregabalin appeared to perform better.

Gabapentin Dosage

Gabapentin is usually started at a low dose and then gradually increased. Be sure to follow your doctor’s instructions. A typical dose ranges between 900 mg and 1,800 mg daily, divided into three doses. You shouldn’t stop taking gabapentin suddenly. Be sure to talk to your doctor about the proper weaning procedure for the dose you’re taking.

Gabapentin Side Effects

Like all drugs, gabapentin comes with a risk of side effects.5 Some are potentially dangerous, while others are not. If you have any of the following side effects while taking gabapentin, call your doctor immediately:

  • Severe weakness or tiredness
  • Upper stomach pain
  • Chest pain
  • New or worsening cough along with fever
  • Difficulty breathing
  • Severe tingling or numbness
  • Rapid, back-and-forth eye movements
  • Pain or difficulty with urination, or no urination
  • Fever
  • Sore throat
  • Swelling in the face or tongue
  • Burning eyes
  • Rash

Side effects that aren’t cause for immediate concern include:

  • Fatigue
  • Dizziness
  • Headache
  • Falling asleep
  • Weight gain

Children taking gabapentin may experience a different set of side effects. Contact your doctor immediately for the following:

  • Changes in behavior
  • Memory problems
  • Inability to concentrate
  • Restlessness, hostility, or aggression

Gabapentin may react negatively with other drugs. Be sure your doctor and pharmacist know everything you’re taking.

Is Gabapentin Right for You?

With evidence being weak and mixed, gabapentin has one clear advantage over Lyrica—it’s generic, and therefore much less expensive. Price, however, is far less important than efficacy.

We all react differently to medications. Some people who fail on other drugs, including Lyrica, may find relief from gabapentin. Talk to your doctor about the benefits and drawbacks gabapentin may have for your overall treatment regimen.

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