Gabapentin and anxiety
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Gabapentin and Anxiety: A Comprehensive Review
Introduction to Gabapentin for Anxiety Treatment
Gabapentin, originally developed as an anticonvulsant, has found extensive off-label use in treating various psychiatric conditions, including anxiety disorders. Despite its widespread use, the evidence supporting its efficacy in anxiety treatment is mixed and warrants a detailed examination.
Efficacy of Gabapentin in Anxiety Disorders
General Anxiety Disorders
Several studies have indicated that gabapentin may be effective in treating various forms of anxiety disorders. A systematic review concluded that gabapentin appears to be beneficial for anxiety, particularly in cases such as preoperative anxiety, anxiety in breast cancer survivors, and social phobia1. Another review highlighted that gabapentin, along with pregabalin, binds to voltage-dependent calcium channels, which are implicated in the pathogenesis of anxiety, suggesting a biological rationale for its use2.
Specific Anxiety Conditions
Breast Cancer Survivors
A randomized controlled trial involving breast cancer survivors demonstrated that gabapentin significantly reduced anxiety symptoms compared to a placebo. The study found that both 300 mg and 900 mg doses of gabapentin were effective, with the lower dose showing the best outcomes for most patients3.
Preoperative Anxiety
The effectiveness of gabapentin in reducing preoperative anxiety has been explored with mixed results. One study found that gabapentin significantly decreased preoperative anxiety in patients undergoing knee surgery8. However, another study reported no significant reduction in preoperative anxiety in patients undergoing total hip arthroplasty5. Similarly, a study on patients undergoing lumbar discectomy found that gabapentin improved preoperative anxiolysis9.
Pediatric Patients
In pediatric patients undergoing thoracic surgery, gabapentin was shown to reduce postoperative anxiety significantly. The study also noted improved patient satisfaction and reduced need for additional antiemetic medication7.
Comparative Efficacy and Safety
Gabapentin vs. Other Treatments
Gabapentin is often considered as an alternative to benzodiazepines, especially for patients with a history of substance use or those reluctant to use controlled substances. Its favorable side effect profile and minimal drug interactions make it an attractive option4 6. However, the evidence for its efficacy as a monotherapy for anxiety is less conclusive, and it is often recommended as an adjunctive treatment1 6.
Safety and Tolerability
Gabapentin is generally well-tolerated, with a low incidence of significant side effects. Its use in anxiety treatment is supported by its minimal interactions and the absence of the need for therapeutic drug monitoring4 6. However, more extensive clinical trials are needed to fully establish its safety and efficacy in larger patient populations1.
Conclusion
Gabapentin shows promise as a treatment for various anxiety disorders, particularly as an adjunctive therapy. While it has demonstrated efficacy in specific conditions such as preoperative anxiety and anxiety in breast cancer survivors, the evidence is mixed for other forms of anxiety. Further research, including larger and more rigorous clinical trials, is necessary to confirm its role in anxiety treatment and to establish standardized dosing guidelines.
Sources and full results
Most relevant research papers on this topic
Use of Gabapentin in the Treatment of Substance Use and Psychiatric Disorders: A Systematic Review
Gabapentin shows potential in treating anxiety disorders and alcohol dependence, but more clinical trials are needed to confirm its effectiveness and safety.
Systematic ReviewBiological rationale and potential clinical use of gabapentin and pregabalin in bipolar disorder, insomnia and anxiety: protocol for a systematic review and meta-analysis
This systematic review aims to assess the efficacy and tolerability of gabapentin and pregabalin in treating bipolar disorder, insomnia, and anxiety, aiming to inform future treatment strategies.
Meta-Analysis
Rigorous JournalA randomized, controlled, double-blinded clinical trial of gabapentin 300 versus 900 mg versus placebo for anxiety symptoms in breast cancer survivors
Gabapentin 300 and 900 mg effectively reduce anxiety symptoms in breast cancer survivors, offering a low-cost alternative for both anxiety and hot flashes treatment.
RCT
Large Human TrialRigorous JournalGabapentin and Anxiety
Gabapentin is an effective and minimally side effects alternative for treating anxiety disorders, both with and without concurrent depression.
Gabapentin does not reduce preoperative anxiety when given prior to total hip arthroplasty.
Gabapentin 600 mg prior to total hip arthroplasty does not significantly reduce preoperative anxiety.
RCTGabapentin: A Review of Published Experience in the Treatment of Bipolar Disorder and Other Psychiatric Conditions
Gabapentin shows potential in treating bipolar disorder, anxiety disorders, behavioral dyscontrol, and substance use disorders, but more well-designed studies are needed to confirm its effectiveness as monotherapy and as an adjunctive treatment with other mood stabilizers.
Systematic ReviewPerioperative Gabapentin in Pediatric Thoracic Surgery Patients-Randomized, Placebo-Controlled, Phase 4 Trial.
Perioperative gabapentin reduces postoperative anxiety in pediatric patients undergoing the Ravitch procedure without significantly affecting pain or side effects.
RCTRigorous JournalPreoperative Gabapentin Decreases Anxiety and Improves Early Functional Recovery from Knee Surgery
Premedication with 1200 mg gabapentin decreases preoperative anxiety and improves postoperative analgesia and early knee mobilization after arthroscopic anterior cruciate ligament repair.
RCT
Highly CitedThe effect of Gabapentin on preoperative anxiety in patients undergoing lumbar discectomy: A-557
Premedication with Gabapentin significantly reduced preoperative anxiety in patients undergoing lumbar discectomy, potentially contributing to improved postoperative pain outcomes.
RCTGabapentin and Pregabalin for the Treatment of Anxiety Disorders
Both gabapentin and pregabalin show potential in treating primary anxiety disorders, particularly those not responsive to antidepressants and benzodiazepines.
Very Rigorous Journal