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Gabapentin for Anxiety

Anxiety, a common mental health condition affecting millions worldwide, is more than just feeling nervous. It’s a complex issue that can disrupt daily life in many ways. From constant worrying to sudden panic attacks, its effects vary from person to person. Luckily, there are several different treatment options available to help, including certain medications, such as Gabapentin.

In this article, we’ll talk about what anxiety is, the different ways it can affect us, and how Gabapentin, a medication originally developed for seizures and nerve pain, might fit into the picture. It’s not a magic fix, but it’s worth discussing with your healthcare provider to see if it could be part of your treatment plan. Let’s take a closer look at Gabapentin and its potential role to help manage anxiety.

First, An Overview of Anxiety

Anxiety is a common mental health issue affecting about 20% of adults each year [4]. Unlike fear, which is an immediate reaction to danger, anxiety keeps people on edge about potential future threats.

This state of worry can impact many aspects of life, from thoughts and physical sensations to behaviors and emotions. For example, it might lead to excessive worrying, a racing heart, avoiding certain situations, or feeling jittery [4].

What Causes Anxiety?

Anxiety often stems from disruptions in how our brain processes emotions and learns from experiences. Factors like genetics, traumatic events, or overprotective parenting can trigger these disruptions [12].

Being sensitive to stress, especially during childhood, can also make someone more prone to anxiety. Additionally, certain traits, like being emotionally sensitive or easily alarmed by threats, can increase the chances of experiencing anxiety [12].

Types of Anxiety Disorders

Anxiety can show up in different forms, each with its own set of symptoms and challenges. Let’s look at a comprehensive list of the most common types of anxiety disorders and their symptoms:

  • Generalized Anxiety Disorder (GAD): This disorder involves excessive worrying about everyday things like finances or health, along with symptoms like restlessness, fatigue, and difficulty concentrating [10].
  • Panic Disorder: People with this disorder often experience sudden and intense panic attacks, which include symptoms such as heart palpitations, sweating, trembling, and a feeling of losing control [3].
  • Social Anxiety Disorder (SAD): This specific anxiety disorder is marked by a strong fear of being judged or scrutinized in social situations, leading to avoidance and distress [14].
  • Obsessive-Compulsive Disorder (OCD): OCD is characterized by intrusive thoughts and repetitive behaviors that can cause distress or interfere with daily life [4].
  • Selective Mutism (SM): Often seen in children, people with SM consistently refuse to speak in specific social situations, even if they speak in other settings [15].
  • Separation Anxiety Disorder (SAD): This involves excessive anxiety when separated from someone the affected person is emotionally attached to, such as a caregiver or parent [6].
  • Agoraphobia: People with agoraphobia have a fear of being in public or crowded places where escape might be difficult, leading to avoidance behaviors [2].
  • Post-Traumatic Stress Disorder (PTSD): PTSD can occur after going through or witnessing a traumatic event. This might lead to symptoms like intrusive thoughts, nightmares, and avoiding anything that reminds the person effected of the trauma [8].

Understanding these different types of anxiety can help individuals recognize the symptoms and seek appropriate help if they or someone they know are experiencing these anxiety symptoms.

What is Gabapentin?

Gabapentin was originally developed to alleviate muscle tension and spasms but was later discovered to effectively control seizures and nerve pain [16]. Approved by the FDA, Gabapentin is prescribed for the following conditions [16]:

  • Postherpetic Neuralgia: Gabapentin effectively reduces the lasting nerve pain complication which can occur after a shingles episode.
  • Epilepsy: Gabapentin is used, in conjunction with other medications, to manage seizures in individuals over the age of 12, and it’s also approved for children aged 3 to 12 with specific types of seizures.
  • Restless Leg Syndrome (RLS): Gabapentin can help manage cases of RLS, a condition characterized by uncomfortable sensations in the legs and an irresistible urge to move them.

Off-Label Uses – Gabapentin for Anxiety

Gabapentin is a medication mainly used for epilepsy and nerve pain. However, doctors will sometimes prescribe it for other things, such as Anxiety, even though it’s not officially approved for those uses (called off-label uses).

People have found that Gabapentin can help with anxiety and similar problems, even though it’s not officially for that. Seemingly it works well for things like feeling very worried or scared, especially if someone has Generalized Anxiety Disorder (GAD), social anxiety, or fear of speaking in public. Gabapentin can also help calm nerves before surgery and is sometimes part of treatment for alcohol addiction because it can help with anxiety and improve sleep [1].

Another positive attribute about Gabapentin is that it doesn’t hurt the liver and can be used by people with kidney problems, seemingly having fewer side effects than similar medicines [1].

Gabapentin can be used for other off-label diagnoses like [16]:

  • Fibromyalgia
  • Bipolar Disorder
  • Post-Menopausal Hot Flashes
  • Essential Tremors
  • Alcohol Use Disorder and Withdrawal
  • Nausea and Vomiting
  • Migraine Prevention
  • Headache
  • Post-Traumatic Stress Disorder (PTSD)
  • Anxiety
  • Comorbid Anxiety Related Disorders
  • Treatment Resistant Depression
  • Major Depressive Disorder
  • Social Phobia
  • Other Mood Disorders

Research indicates that Gabapentin may assist in managing anxiety and could be beneficial when used in conjunction with other treatments for Bipolar Disorder. Gabapentin has been studied to help with alcohol addiction by making withdrawal symptoms less severe and helping people stop drinking [1].

Gabapentin seems useful for more than just epilepsy and nerve pain, but more research is needed to be sure it’s safe and effective for these other uses, so make sure to consult with your healthcare professional to see it’s right for you.

How Does Gabapentin Work?

Although experts are not fully aware of how Gabapentin helps in reducing anxiety, it is thought the following may play a role [9]:

  • Gabapentin seems to affect the release of neurotransmitters, chemicals that help nerve cells communicate with each other. Gabapentin might change how these neurotransmitters are released, but experts are unsure exactly how.
  • Gabapentin also blocks voltage-gated calcium channels. These channels control the flow of calcium ions into nerve cells, which is important for nerve communication. By blocking these channels, Gabapentin might help calm down nerve activity, which could help with anxiety.
  • Another way Gabapentin might work is by affecting a neurotransmitter called gamma-aminobutyric acid (GABA). GABA helps calm down nerve activity in the brain. While Gabapentin doesn’t directly attach to GABA receptors like some other anxiety medicines do, it might still affect how GABA works, which could help make the brain calmer [9].

Side Effects of Gabapentin

Gabapentin, like any medication, may trigger side effects, which vary among individuals. It’s important to be aware of these potential side effects. Here’s what you need to know:

Common Side Effects [16]

  • Dizziness: Feeling lightheaded or unsteady.
  • Fatigue: A general sense of tiredness or lack of energy.
  • Mental difficulties: Problems with concentration, memory, or clear thinking.
  • Visual disturbances: Blurred vision or difficulty seeing clearly.

Less Common Side Effects [16]

  • Drowsiness
  • Nausea or vomiting
  • Swelling in the extremities
  • Weight gain

Serious Side Effects of Gabapentin

Although severe reactions to Gabapentin are rare, they are possible. These can include:

  • Rash
  • Itching
  • Swelling of the face, tongue, or throat

If you or someone you know is taking Gabapentin and experiencing any of these side effects, seek medical attention immediately [16].

Let your doctor know about any side effects you encounter. They may need to adjust the dose of your medication or may recommend a different option.

How Long Does it Take Gabapentin to Work for Anxiety?

Gabapentin’s effects on anxiety can vary from person to person. Generally, the onset of action for Gabapentin in alleviating anxiety symptoms may be noticed within the first week of treatment [16]. However, for some individuals, it may take up to a month to experience significant improvement in anxiety symptoms [16].

What to Avoid When Taking Gabapentin

When prescribed Gabapentin, it’s important to avoid certain actions to ensure safe usage [11,16]:

  • Abrupt Discontinuation: Avoid stopping Gabapentin suddenly, as it can cause withdrawal symptoms like anxiety and nausea. Follow the prescribed tapering schedule provided by your doctor.
  • Alcohol: Refrain from consuming alcohol while taking Gabapentin to prevent increased drowsiness and impaired judgment. Alcohol can interact with Gabapentin and worsen its side effects.
  • Operating Machinery: Gabapentin can cause dizziness and drowsiness, so avoid operating heavy machinery until you know how it affects you.
  • Combining with CNS Depressants: Avoid combining Gabapentin with other central nervous system (CNS) depressants like opioids or benzodiazepines without first consulting a healthcare professional.
  • Pregnancy and Breastfeeding: Use Gabapentin cautiously during pregnancy or breastfeeding, as its safety in these situations isn’t well-established.
  • Kidney Function: Individuals with impaired kidney function may need dose adjustments or closer monitoring while taking Gabapentin.
  • Suicidal Thoughts and Behavior: Be aware of drastic changes in mood or behavior, especially during the initial period of treatment.
  • Allergic Reactions: Seek immediate medical attention if you experience signs of an allergic reaction like skin rash or difficulty breathing.

Always follow the guidance of a healthcare professional and adhere to the prescribed dosage and instructions when using Gabapentin to minimize risks and ensure effectiveness.

Why Would a Psychiatrist Prescribe Gabapentin?

A psychiatrist may prescribe Gabapentin for various reasons, particularly when managing certain psychiatric disorders such as Anxiety disorders, Bipolar Disorder, or Alcohol Dependence [16].

Gabapentin may be used off-label to help alleviate symptoms associated with these conditions, such as anxiety, mood instability, or alcohol cravings [16]. Additionally, Gabapentin’s relatively mild side-effect profile makes it a favorable option for some patients who may not tolerate other medications well [16].

Combining Gabapentin with Other Treatments

Gabapentin is sometimes used in combination with other medications such as selective serotonin reuptake inhibitors (SSRIs) for the treatment of anxiety disorders.

Several studies have shown that Gabapentin can be helpful when used in combination with other medications to treat anxiety disorders, especially in people who have not responded well to standard anxiety treatments [13].

Here is a summary of some of the research:

  • In a small, randomized, controlled trial involving patients with Obsessive-Compulsive Disorder (OCD), Gabapentin was added to their treatment regimen alongside Fluoxetine [7]. The study found some promise in accelerating the treatment response.
  • Another study focused on breast cancer survivors experiencing nonspecific anxiety symptoms. In this randomized, controlled trial, Gabapentin was administered alone over eight weeks, and significant improvement in anxiety symptomatology was observed among participants who received Gabapentin compared to those who received a placebo [7].
  • Similarly, a separate small, placebo-controlled trial, targeting patients with social anxiety disorder, administered Gabapentin as a standalone treatment for 14 weeks [7]. The results indicated some improvement in symptomatology compared to the placebo group.

While these studies suggest that Gabapentin may improve anxiety symptoms in some people, more research is needed to fully understand its effectiveness and safety as a treatment for anxiety disorders. It is important to always consult with a doctor or mental health professional before making any changes to your treatment plan.

Psychotherapy and Medication for Anxiety Treatment

When it comes to treating anxiety disorders, a combination of psychotherapy, especially Cognitive-Behavioral Therapy (CBT), and medication is often recommended.

Studies suggest that both psychotherapy and medication offer comparable effectiveness in addressing various anxiety disorders including Panic Disorder, Social Anxiety Disorder (SAD), and Generalized Anxiety Disorder (GAD) [5]. However, the effectiveness of these treatments can vary based on the specific disorder being addressed.

For instance, in the case of Obsessive-Compulsive Disorder (OCD), studies suggest that psychotherapy tends to be more effective than medication alone [5]. This indicates that individuals with OCD might benefit more from therapy interventions rather than relying solely on medication. Conversely, for certain mood disorders such as Dysthymia, medication might show greater efficacy compared to psychotherapy [5].

By combining psychotherapy with medication, individuals receive a comprehensive approach to managing anxiety disorders. The choice between therapy and medication depends on various factors, including the type of disorder, patient preferences, and treatment costs [5]. This integrated approach ensures that individuals receive tailored treatment that addresses their unique needs and circumstances [5].

Is Gabapentin Right for You?

Gabapentin is just one of the many options available for treating anxiety, whether it’s used alone or in combination with other treatments. It’s crucial for individuals to have open conversations with their healthcare provider about all the medications they’re taking, including any over-the-counter remedies, and to provide a complete list of their medical conditions. This way, their provider can offer the best treatment recommendations for their unique situation.

If you’re struggling with anxiety or other mental health disorders, take the first step towards relief. Contact Neuro Wellness Spa today to schedule an assessment with one of our in-person or online psychiatrists and explore personalized treatment options tailored to your needs. Your journey to improved mental well-being starts here.

References

  1. Ahmed, S., Bachu, R., Kotapati, P., Adnan, M., Ahmed, R., Farooq, U., Saeed, H., Khan, A. M., Zubair, A., Qamar, I., & Begum, G. (2019). Use of Gabapentin in the Treatment of Substance Use and Psychiatric Disorders: A Systematic Review. Frontiers in psychiatry, 10, 228. https://doi.org/10.3389/fpsyt.2019.00228
  2. Balaram K, Marwaha R. Agoraphobia. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554387/
  3. Cackovic, C., Nazir, S., & Marwaha, R. (2023). Panic Disorder. In StatPearls. StatPearls Publishing.
  4. Chand SP, Marwaha R. Anxiety. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470361/
  5. Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F., 3rd (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World psychiatry: official journal of the World Psychiatric Association (WPA), 13(1), 56–67. https://doi.org/10.1002/wps.20089
  6. Feriante, J., Torrico, T. J., & Bernstein, B. (2023). Separation Anxiety Disorder. In StatPearls. StatPearls Publishing.
  7. Greenblatt, H. K., & Greenblatt, D. J. (2018). Gabapentin and Pregabalin for the Treatment of Anxiety Disorders. Clinical pharmacology in drug development, 7(3), 228–232. https://doi.org/10.1002/cpdd.446
  8. Mann, S. K., & Marwaha, R. (2023).Post-traumatic Stress Disorder. In StatPearls. StatPearls Publishing.
  9. Markota, M., & Morgan, R. J. (2017). Treatment of Generalized Anxiety Disorder with Gabapentin. Case reports in psychiatry, 2017, 6045017. https://doi.org/10.1155/2017/6045017
  10. Munir S, Takov V. Generalized Anxiety Disorder. [Updated 2022 Oct 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441870/
  11. NHS. Taking gabapentin with other medicines and herbal supplements. https://www.nhs.uk/medicines/gabapentin/taking-gabapentin-with-other-medicines-and-herbal-supplements/
  12. Penninx, B. W., Pine, D. S., Holmes, E. A., & Reif, A. (2021). Anxiety disorders. Lancet (London, England), 397(10277), 914–927. https://doi.org/10.1016/S0140-6736(21)00359-7
  13. Pollack, M; Matthews, J; Scott, E. Gabapentin as a Potential Treatment for Anxiety Disorders. The American Journal of Psychiatry. 1 Jul 1998. https://doi.org/10.1176/ajp.155.7.992
  14. Rose GM, Tadi P. Social Anxiety Disorder. [Updated 2022 Oct 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555890/
  15. Rozenek, E. B., Orlof, W., Nowicka, Z. M., Wilczyńska, K., & Waszkiewicz, N. (2020). Selective mutism – an overview of the condition and etiology: is the absence of speech just the tip of the iceberg?. Mutyzm wybiórczy – opis zaburzenia i etiologia: czy wybiórczy brak mowy jest zaledwie wierzchołkiem góry lodowej?. Psychiatria polska, 54(2), 333–349. https://doi.org/10.12740/PP/OnlineFirst/108503
  16. Yasaei R, Katta S, Saadabadi A. Gabapentin. [Updated 2022 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493228/
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