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Author: Admin | 2025-04-28
Gabapentin (Neurontin) is not a medication that would make the FDA proud. Less than 1% of its outpatient use is for an FDA indication, and a good portion of the off-label use takes place in psychiatry. These trends sparked a backlash in the 2000s, when Pfizer paid a $1.3 billion fine for misleading marketing practices. Recent reports of misuse of gabapentin and its GABAergic cousin, pregabalin (Lyrica), have added to those concerns. In this article, we’ll look at where gabapentin fits in psychiatric practice.Anxiety disordersGabapentin may be effective for social anxiety and panic disorders at a dose of 900–3600 mg/day. The supporting clinical trials are industry sponsored, and while the methodology is solid (randomized, double blind, placebo controlled), the studies were small—only two trials with a total of 172 participants (Pande AC et al, J Clin Psychopharmacol 1999;19(4):341–348; Pande AC et al, J Clin Psychopharmacol 2000;20(4):467–471). Other studies report benefits in nonspecific anxiety, such as before surgery and in breast cancer survivors, where gabapentin worked better than placebo in two large trials (total n = 630) at a dose range of 300–1200 mg/day (Tirault M et al, Acta Anaesthesiol Belg 2010;61(4):203–209; Lavigne JE et al, Breast Cancer Res Treat 2012;136(2):479–486).By comparison, pregabalin has much better evidence in anxiety disorders, with eight randomized controlled trials at a dose range of 150–600 mg/day involving over 2000 patients with generalized and social anxiety disorders, including several with long-term follow-up (Generoso MB et al, Int Clin Psychopharmacol 2017;32(1):49–55). Pregabalin sees more use for anxiety in Europe, where it has regulatory approval in generalized anxiety disorder, while US psychiatrists lean toward gabapentin. The evidence is clearly in pregabalin’s favor, but gabapentin does have a tolerability advantage, with lower rates of weight gain and ataxia (Shaheen A et al, Pak J Med Sci 2019;35(6):1505–1510).AddictionsDespite concerns about gabapentin misuse, the medication does have a role in alcohol and cannabis use disorders. Patients who take it for alcohol use disorders report fewer days of heavy drinking, with an effect size in the medium range (0.4) from seven randomized controlled trials (Ahmed S et al, Prim Care Companion CNS
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