Gabapentin for Fibromyalgia

What Is Gabapentin?

Gabapentin is somewhat commonly prescribed as a fibromyalgia treatment, however, it is not approved by the U.S. Food and Drug Administration (FDA) for this condition.

It’s often prescribed off-label. However, the drug is chemically related to Lyrica (pregabalin), which is approved for fibromyalgia. In fact, Lyrica is sometimes referred to as the “son of Neurontin.”

Gabapentin is classified as an anti-seizure drug. It’s used to treat epilepsy, neuropathy (pain from damaged nerves), restless legs syndrome, and hot flashes. Fibromyalgia pain is similar to neuropathy, but whether this condition involves nerve damage still isn’t clear.

How Gabapentin Works

Gabapentin is believed to work by altering the release of glutamate and other neurotransmitters in your brain.1 Neurotransmitters send messages from one brain cell to another. Glutamate is helpful for certain things, like learning new information. That’s because it gets your brain cells stirred up and active.

Though, if you have too much glutamate, your brain cells can become overstimulated. That can make all kinds of things go wrong.

Glutamate also helps transmit pain signals in your brain and nerves. Too much glutamate may play a role in hyperalgesia, which essentially turns up the volume of pain.

To counter the effects of glutamate, you have another neurotransmitter called gamma-aminobutyric acid (GABA).2 It calms your cells and quiets your brain. When GABA and glutamate exist in balance with each other, things go well. (It’s likely out of balance in fibromyalgia, though.)

Some diseases and conditions—including fibromyalgia—may interrupt this balance and let glutamate run amok. Gabapentin is believed to reduce your brain’s release of glutamate so the cells can calm down and your brain can function better.

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.

A 2014 review of gabapentin for fibromyalgia and neuropathy found that about 35% of study participants saw their pain drop by at least 50% while on the drug.5 It’s important to note, though, that 21% saw similar drops when taking a placebo.

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

An extended-release form of gabapentin showed promise in one small trial published in Pain Practice.3 Researchers say it improved pain, sleep, and quality of life. This was a preliminary trial, though, so more work needs to be done before we’ll know for sure whether it’s safe and effective long term.

New research supported by the National Institutes of Health’s National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) shows that the anticonvulsant medication gabapentin, which is used for certain types of seizures, can be an effective treatment for the pain and other symptoms associated with the common, often hard-to-treat chronic pain disorder, fibromyalgia.

In the NIAMS-sponsored, randomized, double-blind clinical trial of 150 women (90 percent) and men with the condition, Lesley M. Arnold, M.D., director of the Women’s Health Research Program at the University of Cincinnati College of Medicine, and her colleagues found that those taking gabapentin at dosages of 1,200 to 2,400 mg daily for 12 weeks displayed significantly less pain than those taking placebo. Patients taking gabapentin also reported significantly better sleep and less fatigue. For the majority of participants, the drug was well tolerated. The most common side effects included dizziness and sedation, which were mild to moderate in severity in most cases.

NIAMS Director Stephen I. Katz. M.D., Ph.D., remarked that “While gabapentin does not have Food and Drug Administration approval for fibromyalgia¹, I believe this study offers additional insight to physicians considering the drug for their fibromyalgia patients. Fibromyalgia is a debilitating condition for which current treatments are only modestly effective, so a study such as this is potentially good news for people with this common, painful condition.”

Fibromyalgia is a chronic disorder characterized by chronic, widespread muscle pain and tenderness, and is frequently accompanied by fatigue, insomnia, depression, and anxiety. It affects three million to six million Americans, mostly women, and can be disabling.

The precise cause of fibromyalgia in not known, but research suggests it is related to a problem with the central nervous system’s processing of pain. As with some other chronic pain conditions, people with fibromyalgia often develop a heightened response to stimuli, experiencing pain that would not cause problems in other people. Yet, unlike many other pain syndromes, there is no physical evidence of inflammation or central nervous system damage.

Although Gabapentin has little, if any, effect on acute pain, it has shown a robust effect on pain caused by a heightened response to stimuli related to inflammation or nerve injury in animal models of chronic pain syndromes. Researchers have suspected that it might have the same effect in people with Fibromyalgia. The new research, published in the April 2007 edition of Arthritis & Rheumatism, indicates the suspicions were correct.

Although the researchers cannot say with certainty how Gabapentin helps reduce pain, Dr. Arnold says one possible explanation involves the binding of gabapentin to a specific subunit of voltage-gated calcium channels on neurons. “This binding reduces calcium flow into the nerve cell, which reduces the release of some signaling molecules involved in pain processing,” she says.

How gabapentin improves sleep and other symptoms is less clear, and there are probably different mechanisms involved in fibromyalgia symptoms. “Gabapentin improved sleep, which is an added benefit to patients with fibromyalgia who often report unrefreshing or disrupted sleep,” Dr. Arnold says.

What is important is that people with fibromyalgia now have a potential new treatment option for a condition with few effective treatments. “Studies like this give clinicians evidence-based information to guide their treatment of patients,” says Dr. Arnold.

The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the Department of Health and Human Services’ National Institutes of Health, is to support research into the causes, treatment and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS website at http://www.niams.nih.gov.

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 healthcare provider 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 healthcare provider immediately for the following:

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

Gabapentin may interact negatively with other drugs. Be sure your healthcare provider 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 healthcare provider about the benefits and drawbacks gabapentin may have for your overall treatment regimen.

Which is better for fibromyalgia gabapentin or amitriptyline?

It depends on your symptoms. Research shows that amitriptyline and pregabalin (a drug similar to gabapentin) are equally effective at relieving pain, fatigue, insomnia, and brain fog. Amitriptyline is better at relieving muscular pain while pregabalin is better at easing neuropathic pain.6 Gabapentin also treats neuropathy.

Is Gabapentin for Migraines Right for Me?

In the quest to find effective preventive migraine treatments, healthcare providers sometimes prescribe medications “off-label.” In these cases, a drug has been approved by the U.S. Food and Drug Administration (FDA) for one disorder, but has been found to have positive effects on an unrelated one.

Gabapentin is one such drug. It’s an anti-seizure drug sometimes used to prevent migraines, though there is conflicting scientific evidence supporting its effectiveness in this regard.

In the United States, gabapentin is sold in generic form and under the brand names Neurontin, Gralise, Horizant, and Neuraptine.

Gabapentin has an average rating of 8.0 out of 10 from a total of 105 ratings for the treatment of Migraine. 80% of reviewers reported a positive effect, while 11% reported a negative effect.

As a migraine sufferer since I was 13 yrs old. I am now 56 yrs old. I tried it all. Imitrex, Fiorinol, Maxalt, Fioricet, Relpax, Zomig, Treximet, Cafergot, you name it. Sometimes I ended up in the E.R for a shot of Toradol. Finally I saw a general practitioner. He put me on gabapentin, 400 mg 3x a day. What a miracle. I’ve been on it for over a year now and been TOTALLY headache free. Wish all my other doctors were up with this. Would have saved me a lot of suffering.

Gabapentin is available in a generic version but also comes under the brand names of Horizant, Neurontin, and Gralise. It’s available orally as a liquid solution, capsule, or tablet for extended or immediate release. It can be taken with or without food.

How It Works

Gabapentin is actually an anticonvulsant drug. It’s usually used as a seizure preventative for patients with epilepsy, or to alleviate the nerve pain of shingles. Anticonvulsants are a class of drugs designed to soothe nerve impulses. However, gabapentin is sometimes used for migraine prophylaxis (or prevention).

The precise mechanism of gabapentin’s action is not well known. Even though this drug has a similar structure to a brain neurotransmitter called GABA (gamma-aminobutyric acid), it has no effect on its receptors. It is believed that gabapentin blocks calcium channels, modulating the release of excitatory neurotransmitters.

Gabapentin and Migraine Prevention

Being an anticonvulsant, the theory behind using gabapentin for migraines is that its ability to calm nerve impulses could help avert migraine pain. Gabapentin could ease the brain’s electrical activities by settling excitatory neurotransmitters and blocking calcium channels.

However, this is mostly theoretical. Gabapentin’s exact role in migraine prevention isn’t well understood by researchers, and more research is needed to figure out what makes it work.

Gabapentin isn’t usually prescribed as a primary migraine preventative. It’s typically added to work in conjunction with other therapies, or used when other medications haven’t worked for the patient. As a preventative measure rather than an acute treatment, gabapentin needs to be taken continuously.

Gabapentin for Migraines Is an “Off-Label” Use

When a drug is used for something other than its purpose approved by the FDA, it’s called an off-label use. Since the FDA regulates the approval and testing of drugs (and not how doctors choose to prescribe them), your doctor is allowed to prescribe gabapentin for migraines if it seems like the right solution.

Gabapentin is primarily used to treat epilepsy in people older than 12 and partial seizures in children ages 3 to 12. It is also FDA-approved to treat a condition called postherpetic neuralgia—the nerve-related pain complication of a herpes zoster attack (shingles) that can occur in adults.3

Besides these uses, gabapentin is used off-label for a variety of other conditions like migraine prevention, as well as diabetic neuropathy, restless legs syndrome, and fibromyalgia.

Because of its benefit in treating these and other issues, gabapentin is what’s known as an adjuvant analgesic—a drug that can help control pain, despite it not being primarily intended to do so. Gabapentin may be used alone or with other medications when necessary.

It’s important to note, however, that The American Academy of Neurology (AAN) and the American Headache Society (AHS) do not list gabapentin as “effective” or “probably effective” for preventing migraines in their 2012 guidelines. Instead, gabapentin is given a level U rating, which means the evidence is conflicting or inadequate to support or refute its use for migraine prevention.

Gabapentin for Migraine Dosages

The recommended daily dose for gabapentin usually falls between 300 mg and 3,600 mg. Your dose may depend on your overall health, age, and other conditions.

While gabapentin is prescribed under the care of a doctor, be careful to take only the recommended amount, and talk to your doctor about how to wean off of it if that becomes necessary.

What the Research Says

The research behind gabapentin for migraines is a bit mixed, but does show some promise.

The American Academy of Neurology (AAN) released a statement in 2013 which said there was insufficient evidence supporting gabapentin for migraine prophylaxis.

In 2014, a study conducted on gabapentin for episodic migraine found that some other antiepileptic drugs could be considered first-line migraine preventatives, but found inadequate evidence to recommend gabapentin for migraine prevention, saying it’s “not effective and commonly causes adverse effects.”

A 2016 study of gabapentin for headache disorders did reveal some benefit. However, it stopped short of recommending it as a primary migraine therapy.

How should I take gabapentin?

Take gabapentin exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take in larger or smaller amounts or for longer than recommended.

If your doctor changes your brand, strength, or type of gabapentin, your dosage needs may change. Ask your pharmacist if you have any questions about the new kind of gabapentin you receive at the pharmacy.

Both Gralise and Horizant should be taken with food.

Neurontin can be taken with or without food.

If you break a Neurontin tablet and take only half of it, take the other half at your next dose. Any tablet that has been broken should be used as soon as possible or within a few days.

Swallow the capsule or tablet whole and do not crush, chew, break, or open it.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

Do not stop taking this medicine suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor’s instructions about tapering your dose.

In case of emergency, wear or carry medical identification to let others know you have seizures.

This medicine can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using gabapentin.

Store both the tablets and capsules at room temperature away from light and moisture.

Store the liquid medicine in the refrigerator. Do not freeze.

Dosing information

Usual Adult Dose for Epilepsy:

Initial dose: 300 mg orally on day one, 300 mg orally 2 times day on day two, then 300 mg orally 3 times a day on day three
Maintenance dose: 300 to 600 mg orally 3 times a day
Maximum dose: 3600 mg orally daily (in 3 divided doses)
-Maximum time between doses in the 3 times a day schedule should not exceed 12 hours

-The safety and effectiveness of gabapentin available under the trade name Gralise or Horizant in patients with epilepsy has not been studied.

Use: Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization

Usual Adult Dose for Postherpetic Neuralgia:

-Initial dose: 300 mg orally on day one, 300 mg orally 2 times day on day two, then 300 mg orally 3 times a day on day three
-Titrate up as needed for pain relief
-Maximum dose: 1800 mg per day (600 mg orally 3 times a day)
Gabapentin available under the trade name Gralise:
-Maintenance dose: Gralise should be titrated to 1800 mg orally once daily with the evening meal.
-Recommended titration schedule:
Day 1: 300 mg orally with the evening meal
Day 2: 600 mg orally with the evening meal
Days 3 through 6: 900 mg orally with the evening meal
Days 7 through 10: 1200 mg orally with the evening meal
Days 11 through 14: 1500 mg orally with the evening meal
Day 15: 1800 mg orally with the evening meal

COMMENT:
-Gralise is not interchangeable with other gabapentin products because of differing pharmacokinetic profiles that affect the frequency of administration.

Gabapentin enacarbil extended release tablets are available under the trade name Horizant:
-The recommended dosage is 600 mg orally 2 times a day. Therapy should be initiated at a dose of 600 mg orally in the morning for 3 days of therapy, then increased to 600 mg 2 times a day (1200 mg/day) on day four.

COMMENT:
Gabapentin enacarbil extended release tablets available under the trade name Horizant and gabapentin are not interchangeable.

Use: Postherpetic neuralgia

Usual Adult Dose for Restless Legs Syndrome:

Gabapentin enacarbil available under the trade name Horizant:
600 mg orally once daily with food at about 5 PM

Use: For the treatment of moderate-to-severe primary Restless Legs Syndrome (RLS) in adults

Usual Pediatric Dose for Epilepsy:

Less than 3 years: Not recommended

Greater than or equal to 3 and less than 12 years:
Starting Dose: Ranges from 10 to 15 mg/kg/day in 3 divided doses
Effective Dose: Reached by upward titration over a period of approximately 3 days; the effective dose in patients 5 years of age and older is 25 to 35 mg/kg/day in divided doses (3 times a day). The effective dose in pediatric patients ages 3 and 4 years is 40 mg/kg/day and given in divided doses (3 times a day). Gabapentin may be administered as the oral solution, capsule, or tablet, or using combinations of these formulations. Dosages up to 50 mg/kg/day have been well tolerated in a long term clinical study. The maximum time interval between doses should not exceed 12 hours.

Greater than 12 years:
-Initial dose: 300 mg orally on day one, 300 mg orally 2 times a day on day two, then 300 mg orally 3 times a day on day three
-Maintenance dose: 900 to 1800 mg orally in 3 divided doses; the dose may be increased up to 1800 mg/day. Dosages up to 2400 mg/day have been well tolerated in long term clinical studies. Doses of 3600 mg/day have also been administered to a small number of patients for a relatively short duration, and have been well tolerated. The maximum time between doses in the three times a day schedule should not exceed 12 hours.

Use: Adjunctive therapy in the treatment of partial onset seizures, with and without secondary generalization in patients 3 years of age and older

Side Effects of Gabapentin

LIke many other FDA-approved drugs, gabapentin could have side effects for many patients. Those include:

- Swelling of feet or limbs
- Unexpected or atypical eye movements
- Loss of coordination
- Blurry vision or other vision changes

Better Options for Migraine Prevention

There are plenty of migraine preventative drugs on the market which you can discuss with your doctor.

And as you probably know, living a healthy lifestyle could also help you reduce the migraine attacks you have to endure. Getting plenty of sleep, a healthy diet, and physical activity are all important.

Many migraine relief tools could reduce your suffering when you’re hit with a migraine, or help ward off more of them. These include supplemental Vitamin B2 and magnesium, which could help reduce migraine frequency. Axon Optics glasses, which have been shown to help 85% of users, are at the top of our list.

Interactions

Drinking alcohol may make some side effects of gabapentin more severe.

Types of drugs that are known to interact with gabapentin and may cause problems include:

- Opiate pain medications, including Vicodin (hydrocodone) and morphine, among others
- Naproxen (Aleve, Naprosyn, and others)
- Medications used for heartburn, including Mylanta, Maalox, and cimetidine

If you do dipstick tests to check your urine for protein, tell your healthcare provider. Gabapentin may affect the results.

Your healthcare provider can advise you on whether you should avoid taking certain drugs with gabapentin entirely, or if the timing or dosage simply need to be adjusted.

Contraindications

Currently, there is not enough research or well-controlled studies on humans to deem this medication safe for expecting mothers.3 Contact your healthcare provider to discuss whether the benefits of use may outweigh the risks in your case.

Gababentin should be avoided by people with chronic kidney disease or myasthenia gravis.

Does gabapentin help nerve pain?

Gabapentin is approved to treat the type of nerve pain (neuralgia) that results from nerve damage. Gabapentin is used to treat neuralgia caused by a herpes zoster viral infection, also known as shingles. This pain is called post-herpetic neuralgia (PHN), and it can be severe and chronic. Gabapentin is also used to treat pain from diabetic neuropathy, which happens when nerves in the feet damaged by diabetes cause chronic burning pain.

The exact way that gabapentin works to relieve pain is not known. It may change the way the body senses and reacts to pain. Gabapentin is used to manage long-term (chronic) pain, not to be taken for pain as needed. Chronic pain can interfere with sleep and work, and lead to depression.

Studies show that pain relief may start within one week and reach a maximum effect in about 4 weeks. It can take this long because gabapentin is usually started at a low dose and gradually increased over time until it works.

For treating neuralgia, gabapentin is often started at 300 mg per day and gradually raised by 300 mg per day. One 2017 review of 37 studies found that pain relief usually occurs at a dose of 1,200 mg or more.

The same review compared gabapentin to an inactive medicine (placebo) in almost 6,000 adults with chronic pain from PHN or diabetic neuropathy. Study participants were given either gabapentin or a placebo for 4 to at least 12 weeks. The results showed that 30-40% of people taking gabapentin were able to reduce their pain by half or more, compared to 10-20% of people taking the placebo.

Although some people may get significant relief, others may have side effects without relief of pain. More than half of people taking gabapentin did not get significant relief and had side effects from the drug.

According to the review, about 60% of people taking gabapentin had side effects, including:

- Dizziness
- Sleepiness
- Water retention (edema)
- Clumsiness while walking (ataxia)

It does not typically make pain worse: In trials comparing gabapentin side effects to placebo side effects, only 1% of people reported increased pain, and this was the same for gabapentin and placebo.

Once you find the dose that relieves neuralgia for you, it is important not to stop taking it suddenly. Stopping suddenly can lead to withdrawal symptoms such as:

- Anxiety
- Insomnia
- Nausea
- Pain
- Sweating

Gabapentin Dosage for Partial Seizures

Gabapentin is used to treat epilepsy. It’s also taken for nerve pain. Nerve pain can be caused by different illnesses, including diabetes and shingles, or it can happen after an injury.

Occasionally, gabapentin is used to treat migraine headaches.

Gabapentin is available on prescription. It comes as capsules, tablets, and a liquid that you drink.

A doctor will need to sign your prescription by hand, and you’ll need to collect your medicine within 28 days. You’ll need to show the pharmacist proof of your identity.

How gabapentin works ?

In epilepsy, it’s thought that gabapentin stops seizures by reducing the abnormal electrical activity in the brain.

With nerve pain and migraine, it’s thought to interfere with pain messages travelling through the brain and down the spine to block pain.

Gabapentin dosage for partial seizures

Gabapentin is FDA-approved as adjunctive therapy for partial seizures in adults and children 3 years of age or older.

Standard gabapentin dosage for adults: 300 to 600 mg taken three times per day by mouth.
Maximum gabapentin dosage for adults: 3600 mg daily in three divided doses.
Renally impaired patients (kidney disease)—dose amount and dose frequency adjustment:

1. Creatinine clearance of 30-59 ml/min: 200 to 700 mg twice per day
2. Creatinine clearance of 16-29 ml/min: 200 to 700 mg once per day
3. Creatinine clearance of 15 ml/min or less: 100 to 300 mg once per day decreased proportionately (1/15 per whole number value) for each decrease in creatinine clearance
4. Hemodialysis: dose is dependent on estimated creatinine clearance; a supplemental dose of 125 to 350 mg is given after dialysis

Gabapentin Dosage for Children

Gabapentin is used to help control partial seizures (convulsions) in the treatment of epilepsy. This medicine cannot cure epilepsy and will only work to control seizures for as long as you continue to take it.

Gabapentin is also used to manage a condition called postherpetic neuralgia, which is pain that occurs after shingles.

Gabapentin works in the brain to prevent seizures and relieve pain for certain conditions in the nervous system. It is not used for routine pain caused by minor injuries or arthritis. Gabapentin is an anticonvulsant.

This medicine is available only with your doctor’s prescription.

This product is available in the following dosage forms:

- - Capsule
  - Tablet
  - Tablet, Extended Release, 24 HR
  - Solution
  - Suspension

Gabapentin Dosage for Children

Please remember that you are not allowed to buy Gabapentin Online if you are 19 years old and under. Please find a local doctor to prescribe you Gabapentin prescription and buy it in a local Gabapentin pharmacy.

Gabapentin is FDA-approved as a secondary treatment for partial seizures in children 3 years or older with epilepsy. The use of gabapentin in children for any other medical condition is not FDA-approved. Dosing will be determined by both the child’s age and weight.

Gabapentin dosage by age for children older than 3 years
Age (yr)	Recommended dosage
3-4 yrs	40 mg per kg (18.2 mg/lb) of body weight divided into three doses Maximum: 50 mg per kg (22.7 mg/lb) of body weight daily
5-11 yrs	20-35 mg per kg (9.1-15.9 mg/lb) of body weight divided into three doses Maximum: 50 mg per kg (22.7 mg/lb) of body weight daily
12 yrs or older	300-600 mg taken three times per day Maximum: 3600 mg per day

Gabapentin Can be Used to Treat Anxiety and Depression

Gabapentin is an anticonvulsive medication which first discovered in the 1970s in Japan.

Its original use was as a muscle relaxer and anti-spasmodic medication, but later, it was discovered the potential of the medication as anticonvulsive medication and as an adjunct to stronger anticonvulsants.

Gabapentin is an anticonvulsant medication that got FDA approval for partial seizure therapy in 1993. Currently, gabapentin has FDA approval for:

- Postherpetic neuralgia
- Adjunctive therapy in the treatment of partial seizures with or without secondary generalization in patients over the age of 12 years old with epilepsy, and the pediatric population, 3 to 12 year-olds with a partial seizure
- Moderate to severe restless leg syndrome (RLS) moderate to severe

It also has off-label use for neuropathic pain, fibromyalgia, bipolar disorder, postmenopausal hot flashes, essential tremors, anxiety, resistant depressant and mood disorders, irritable bowel syndrome (IBS), alcohol withdrawal, postoperative analgesia, nausea and vomiting, migraine prophylaxis, headache, interstitial cystitis, painful diabetic neuropathy, social phobia, generalized tonic-clonic seizures, pruritus (itching), insomnia, post-traumatic stress disorder (PTSD), and refractory chronic cough.

In one placebo-controlled, retrospective study that investigated the effects of gabapentin on about 700 patients with refractory partial seizure disorder, there was an improvement in overall well-being in patients. The effect prompted a controlled investigation of the drug in primary psychiatric conditions.

An important benefit of gabapentin is that there is no interaction with valproate, lithium, and carbamazepine. Also, gabapentin has minor side effects.

Gabapentin in the Treatment of Anxiety and Depression

Gabapentin is rarely prescribed for patients with only anxiety disorder but is commonly prescribed for patients with bipolar disorder to reduce anxiety levels. Clinicians can also use it for patients who have anxiety and depression. Since anxiety is a coping skill, there is no drug to treat anxiety, but the medications used for this purpose make it possible to live at the moment, giving patients a chance to undergo anxiety treatment with non-pharmaceuticals. Even though the studies show that gabapentin is ineffective in the treatment of bipolar disorder, a case-control study with 60 patients in an acute phase of mania had a significant reduction in symptoms of anxiety with lithium and 900 mg of gabapentin. In another study with 21, mixed-state patients refractory to mood stabilizers received gabapentin (up to 2000 mg per day) for eight weeks, and patients with depressive symptoms had significant improvement in their CGI-BP (Clinical Global Impression-Bipolar) scores.

A meta-analysis of 7 trials pointed to gabapentin’s greater efficacy versus placebo in generalized anxiety disorder (GAD), although the effect size was approximately 0.35 for mental anxiety symptoms. A study of 153 patients who responded to the initial treatment of 450 mg per day for maintenance treatment of social anxiety disorder.

There are no clinical studies on the effectiveness of gabapentin as monotherapy or adjunctive therapy in major depressive disorders. However, there are case reviews that show some patients with depression who are refractory to standard antidepressants but showed therapeutic improvement when using gabapentin as adjunctive therapy.

In a randomized, double-blind study, with 130 patients that had under eye surgery, a one-time dose of 600 mg gabapentin significantly reduced the perioperative anxiety compared to a placebo. However, there was no significant difference compared to melatonin.