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

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Try out PMC Labs and tell us what you think. Learn More. Gabapentin is frequently used in the treatment of anxiety disorders. However, there are no randomized controlled trials on the effectiveness of this medication in generalized anxiety disorder GADand there are only a few case reports. We present a case of a year-old female with a psychiatric history of GAD. The patient Gabapentin to treat anxiety benzodiazepines after more than 7 years of daily treatment which led to rebound anxiety, benzodiazepine withdrawal symptoms, and suicidal ideation. She was psychiatrically hospitalized and started on gabapentin.

Over the next 10 months of outpatient follow-up, she attempted to taper off gabapentin due to personal preference to limit medications. During this time, we observed a clear dose-response pattern of gabapentin on GAD symptoms. In the absence of controlled studies, these findings may offer important information about the effectiveness of gabapentin in GAD. While gabapentin is increasingly being used to treat generalized anxiety disorder GADlittle is known about its effectiveness on GAD symptoms. The patient presented here has a relatively straightforward psychiatric history, with GAD playing a prominent role.

Her repeated attempts to discontinue gabapentin offer a rare opportunity to observe its effect on her symptoms at different doses. In the absence of randomized controlled trials, these findings may offer clinically important clues about dosing and effectiveness of gabapentin in GAD.

The patient is a year-old Caucasian female. She has had four prior inpatient psychiatric hospitalizations for depression and anxiety with suicidality. Social history is pertinent for physical and emotional abuse in childhood.

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She does not use alcohol, tobacco, or illicit substances. She drinks up to two cups of caffeinated coffee in the morning. She had multiple unsuccessful cognitive behavioral therapy trials. Three months prior to presentation, benzodiazepines were tapered and the patient's anxiety recurred. Her symptoms included persistent and excessive worry, restlessness, feeling on edge, fatigue, poor concentration, irritability, insomnia, and dysphoric mood, as well as diaphoresis, palpitations, tremulousness, and muscle tension. She was unable to complete activities of daily living.

She developed suicidal ideation and required two psychiatric hospitalizations in a one-month span. Ultimately, benzodiazepines were successfully discontinued and she has remained off of these medications throughout 10 months of outpatient follow-up. We considered generalized anxiety disorder, panic disorder, posttraumatic stress disorder, MDD, obsessive compulsive disorder, anxiety due to another medical condition, such as thyroid disease, medication-induced mood, and anxiety disorder from prolonged benzodiazepine withdrawal. During her outpatient follow-up, anxiety was assessed using a combination of Likert-scale ratings and the generalized anxiety disorder 7-item GAD-7 patient self-report questionnaire.

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She did not tolerate hydroxyzine on as needed basis and stopped using this medication several days after leaving the hospital. On day 30, she requested to stop gabapentin as her anxiety was well controlled. However, her anxiety rapidly returned. At this point, her anxiety became debilitating. Relationship between gabapentin dose and anxiety. Anxiety was assessed on a 0—10 scale; GAD-7 scores are added where available. Day 0 is the day of discharge from the last hospitalization. Gabapentin is expressed in total daily doses. Measurements were not continuous, but for clarity lines connect the values obtained during in-office follow-up appointments or telephone conversations a total of 27 measurements in days.

On daythe patient attempted a third self-initiated gabapentin taper as she believed gabapentin was causing increased fatigue. At the same time, sertraline was cross-tapered to amitriptyline to treat chronic migraine. Her headache temporarily resolved, but anxiety continued to impact her functioning. However, shortly thereafter, the patient had a of psychosocial stressors that led to increased anxiety GAD-7 score of At the end of this period, she started to develop some depressive symptoms Patient Health Questionnaire 9 score of 17though her anxiety remained mild.

Venlafaxine was therefore initiated. The patient remains on gabapentin and venlafaxine at the time of manuscript submission. The potential anxiolytic effect of gabapentin was first observed in animal models [ 1 ]. Randomized controlled trials in patients with anxiety disorders found that gabapentin is effective in treating social phobia [ 2 ]. Gabapentin was generally not effective in treatment of panic and agoraphobia symptoms.

However, a subgroup of more severely ill patients, particularly women, did show some improvement [ 3 Gabapentin to treat anxiety. To our knowledge, there are no controlled studies on gabapentin use in GAD [ 4 ]. A compiled study of 18 patients with various anxiety disorders, one of which had GAD, found beneficial effects on anxiety symptoms [ 5 ]. However, that patient had alcohol use disorder and had decreased drinking during this period [ 6 ]. Despite this lack of efficacy data, our clinical experience indicates that gabapentin is frequently used to treat patients with GAD. The patient presented here has the most detailed description of gabapentin dose-response on GAD symptoms available in the literature thus far.

On average, we contacted the patient every 11 days, for a total of 27 measurements in days of outpatient follow-up. This allows us to determine a detailed dose-efficacy response for this patient.

Can you use gabapentin for anxiety?

As shown in Figure 1there was a clear inverse relationship between gabapentin dose and anxiety. This is particularly encouraging as the patient had multiple failed therapeutic trials of SSRIs, SNRIs, tricyclic antidepressants, bupropion, mirtazapine, aripiprazole, and trazodone targeting anxiety and mood.

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Compared to these medications, gabapentin has a favorable side effect profile and generally represents lower risk in overdose [ 7 ]. She quickly discontinued hydroxyzine but continued the other three medications until day During this time, gabapentin was the only medication with repeated dose adjustments, and no other medication changes were temporally correlated with the fluctuating levels of anxiety in this patient.

Despite some degree of polypharmacy, the patient's fluctuating anxiety levels were therefore most clearly associated with gabapentin dose changes. At the end of this period, the patient developed symptoms consistent with MDD, warranting initiation of venlafaxine; however, she showed no s of anxious distress, again consistent with gabapentin's efficacy in managing her anxiety symptoms.

Treatment of generalized anxiety disorder with gabapentin

Little is known about the interaction between gabapentin and autoimmune mechanisms. Worsening of myasthenia Gabapentin to treat anxiety with gabapentin has been reported, and one case of gabapentin-induced bullous pemphigoid is currently available in the literature [ 89 ]. To our knowledge, there have been no controlled studies or case reports indicating that patients with a high autoimmune disease burden should have an altered mood or anxiety response to gabapentin.

However, this is a potential consideration that deserves further research. Overall, we believe that no convincing evidence exists at this time to suggest that this patient's favorable response to gabapentin is linked to her autoimmune predisposition or that using gabapentin in such a patient carries an increased risk of adverse events. We did not measure gabapentin's serum levels in this patient. Firstly, the target serum concentration for treating anxiety with gabapentin is not known and therefore is not clinically useful at this point. Secondly, there was no evidence that the patient falsely reported her gabapentin use, as she was forthcoming with her psychiatrist about her repeated episodes of self-initiated dose reductions and periods of taking the medication as prescribed.

Additionally, medication refills were requested and filled at the expected times for the doses that she was taking.

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Gabapentin has a complex mechanism of action that only modestly overlaps with other antiepileptics. This affects cellular trafficking of voltage-dependent calcium channels likely causing an overall reduction in calcium currents and potentially impacting neurotransmitter release in currently unknown ways [ 10 ]. Binding to this receptor complex has also been postulated to decrease the formation of excitatory neuronal synapses, thus potentially decreasing overall excitatory tone and modulating anxiety [ 11 ]. Other potential mechanisms of action that may target anxiety symptoms include modulation of GABA biosynthesis and nonsynaptic GABA neurotransmission [ 1012 ].

It is notable that although gabapentin does not directly bind to or modulate GABA-A receptors like benzodiazepines, the above mechanisms may indirectly impact GABAergic tone and provide a treatment option not only for anxiety but also for components of both benzodiazepine and alcohol withdrawal [ 101314 ]. While this patient indeed found gabapentin useful for her benzodiazepine discontinuation, a larger study found that gabapentin was not associated with decreased benzodiazepine use in psychiatric patients [ 15 ].

We hypothesize that it was gabapentin's efficacy in treating GAD symptoms that allowed for ongoing benzodiazepine abstinence. Future research is necessary to determine whether patients with GAD who respond positively to gabapentin also have decreased benzodiazepine utilization. This is particularly important given the risks of benzodiazepines in older adults [ 16 ]. There has been growing concern about the Gabapentin to treat anxiety for gabapentin abuse. However, the literature is limited and suggests that gabapentin is predominantly abused by patients with other substance use disorders, notably opioid use disorder [ 17 — 21 ].

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Our patient showed no s of abuse or increasing demand for gabapentin and seems to be low risk based on available literature. Nevertheless, it is important for physicians to be aware of the potential for gabapentin abuse when considering prescribing it, particularly for patients with substance use disorders.

Informed consent for the publication of this manuscript has been obtained from the patient. The authors declare that there are no conflicts of interest regarding the publication of this paper.

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National Center for Biotechnology InformationU. Journal List Case Rep Psychiatry v. Case Rep Psychiatry. Published online Dec Matej Markota and Robert J. Robert J. Author information Article notes Copyright and information Disclaimer. Corresponding author. Matej Markota: ude. This is an open access article distributed under the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Gabapentin is frequently used in the treatment of anxiety disorders. Introduction While gabapentin is increasingly being used to treat generalized anxiety disorder GADlittle is known about its effectiveness on GAD symptoms.

Case Presentation 2. Presenting Features The patient is a year-old Caucasian female. Differential Diagnoses We considered generalized anxiety disorder, panic disorder, posttraumatic stress disorder, MDD, obsessive compulsive disorder, anxiety due to another medical condition, such as thyroid disease, medication-induced mood, and anxiety disorder from prolonged benzodiazepine withdrawal.

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