Neurontin itself is not a cure for anxiety disorders.
Its active substance, gabapentin, was created to help patients with seizures and is prescribed for specific types of nerve pain. Nonetheless, there is a phenomenon known as off-label prescribing, and some doctors write a gabapentin prescription after patients explain racing thoughts, sleeping trouble or the physical tension that often accompanies anxiety.
We will consider both positive and negative implications of such a scenario.
On one hand, for some patients, gabapentin is an almost guaranteed relief. For others it mainly induces sleepiness.
Why is gabapentin prescribed for anxiety?
Although the name of the substance may suggest a mechanism similar to benzodiazepines, it binds to a part of the calcium channel and affects the release of various messengers in the nervous system, making the process a bit indirect.
How exactly those changes relate to the symptoms of generalized anxiety is still unclear.
Several small studies have shown that gabapentin may help people with social anxiety and certain panic attacks. It also was studied and is sometimes used in case of anxiety-related conditions during surgery. However, the clinical evidence is not strong, and compared to psychotherapy, SSRIs, and SNRIs, gabapentin has a thinner edge of research behind it.
There is no significant evidence for treating generalized anxiety with gabapentin, while it is occasionally prescribed for this condition off-label.
When to consider Neurontin?
When a patient suffers from other conditions alongside anxiety, such as nerve pain, restless sleep or any other gabapentin-indicated problem. If those are mild and anxiety is the main issue, it may be discussed with a healthcare provider.
Also, if first-line treatments were ineffective or caused intolerable side effects. However, that does not mean that gabapentin is a medication to begin the treatment with anxiety.
What does it feel like?
Some patients report that gabapentin helps them to mute the physical side of anxiety, such as muscle tension. Their sleep becomes deeper and more consistent, and the overall constant stress is calmer, without the constant need to “run somewhere”.
Same effects often overlap with sleepiness and dizziness. Especially on the first days or when the dose of gabapentin was recently increased – for those days, the side effects may be severe. A person may feel “drugged”, clumsy, have issues with attention or coordination.
Taking gabapentin right before driving somewhere unfamiliar or working somewhere unfamiliar is not recommended – give your body some time to adjust to the new substance and its effects.
The starting dose of gabapentin is usually lower. Also, there is no single standard dose of gabapentin for anxiety since it is an off-label use. Kidney function also impacts the dose since impaired kidney function means that the substance is excreted slower than expected.
Do not rely on someone’s else gabapentin dose – calculate yours together with your healthcare provider.
Is Neurontin safer than a benzodiazepine?
Overall, the risks of gabapentin are different from risks of alprozolam, clonazepam or diazepam. However, calling it “non-addictive” may be an oversimplification.
Physical dependence on gabapentin is possible, especially if the dose is high or the substance is used regularly. Stopping abruptly may cause anxiety, insomnia, tachycardia, nausea, diaphoresis and, in case of gabapentin used for seizures, seizures. A tapered dose is always safer.
Misuse of gabapentin also overlaps with substance use disorders – in people who already have a history of abuse or dependence, using other addictive substances is possible.
The interactions with opioids are also of concern – gabapentin is sometimes used alongside those to manage pain. However, opioids, sleeping pills, anxiety medications and alcohol may cause respiratory depression, which is especially dangerous for the elderly or people with lung conditions.
A glass of wine may feel much stronger than it is supposed to be during gabapentin treatment. Until you learn how exactly Neurontin affects your perception and mood, alcohol abstinence is a safer option.
The side effects users may report
Drowsiness, lightheadedness and swelling are few common side effects reported by patients on gabapentin. Others include vision changes, impaired motor functions, weight gain, and tremor.
More serious effects are rare, but not impossible. Since gabapentin is an antiseizure medication, there is a warning about suicidal thoughts and behavior, although it may hardly be the reason for such thoughts to emerge. Depression, sudden changes in mood or sudden development of frightening thoughts should be brought to the attention of a healthcare provider.
Difficulty breathing and extreme drowsiness may also be signs of an emergency, especially if opioids or other central depressants are involved. If someone seems to be struggling to breathe or their lips have a bluish color, wake them up and seek emergency help. Same goes for trying to wake someone up who is unconscious or not responding to stimuli.
Anxiety medications: how do they compare?
In case of generalized anxiety or panic attacks, psychotherapy and medications with proven efficacy are usually the first line of defense. SSRIs or SNRIs may be needed for several weeks until the therapeutic dose is found and the patient begins to feel better. Such medications may be inconvenient due to their side effects, but their benefits greatly outweigh the risks.
Buspirone is another medication used for generalized anxiety, although it is not an immediate solution. Since it is also a non-benzodiazepine, our Buspar for anxiety guide may help you to learn more about buspirone and the expectations from it.
Neurontin may fit into the picture as a medication to help with sleep, if someone cannot fall asleep due to anxiety symptoms. Or there were several other medications with unsatisfactory effects, or a psychiatrist finds a benefit in prescribing it alongside other anxiety treatments.
The main point is to understand what exactly the healthcare provider prescribes: a medication with an off-label status and a thin layer of evidence for the condition or a proper anxiety medication with a thorough list of benefits and potential risks.
Neurontin for anxiety: is there a benefit for the patient?
Neurontin is not a first-time medication for anxiety. However, some people find it beneficial alongside other treatments or when they find the proper gabapentin dose for anxiety. The individual tolerance is key, alongside the evaluation of the benefits and risks.
