Gabapentin for Anxiety: Uses, Dosage, Side Effects, & More

What Is Gabapentin?

Gabapentin is part of the drug class called gabapentinoids. These drugs have a similar structure to a chemical in the brain called gamma-aminobutyric acid (GABA).¹ However, despite the similar structure, it does not affect GABA function. Gabapentin may impact specific calcium channels in the body. However, the exact function of gabapentin is not fully known. Gabapentin is commonly known by its brand names, including Neurontin, Horizant, and Gralise.

Gabapentin is FDA-approved for the following treatments:^{2, 3}

• Postherpetic nerve pain (burning pain caused by shingles)
• Management of certain seizure disorders
• Restless leg syndrome

In addition to its FDA-approved uses, gabapentin can be prescribed off-label. When a medication is used off-label, it means a healthcare provider prescribes the medication for a condition not approved by the FDA. Off-label use occurs when a healthcare provider, based on their professional judgment, believes the medication will still offer benefit to an individual.

Off-label uses of gabapentin include:³

• Neuropathic pain
• Fibromyalgia
• Bipolar disorder
• Postmenopausal hot flashes
• Essential tremors
• Anxiety
• Irritable bowel syndrome
• Diabetic neuropathy
• Insomnia

How Does Gabapentin Work?

The exact way that gabapentin works is not fully known or understood. Gabapentin has a similar structure to a chemical in the brain called gamma-aminobutyric acid (GABA). However, gabapentin does not act like GABA in the brain and does not impact GABA functioning. Instead, gabapentin is known to impact specific calcium channels of nerve cells. This helps to calm down excessive nerve activity. By doing so, gabapentin can alleviate seizures and dull nerve pain.

Does Gabapentin Reduce Anxiety Symptoms?

The calming impact of gabapentin on the brain may explain why it can be helpful in the management of anxiety symptoms. When prescribed for the treatment of anxiety, gabapentin is being used off-label. In other words, it is being used to treat a condition not approved by the FDA, but a healthcare provider believes it may benefit an individual.

Types of Anxiety Treated with Gabapentin

Gabapentin and its use for anxiety disorders have not been well-studied. However, there is some evidence that gabapentin can improve anxiety in cancer survivors with anxiety and in individuals with social anxiety disorder. One study also found that gabapentin may lead to a faster response when treating obsessive-compulsive disorder with fluoxetine (Prozac).³

There are reports that gabapentin has been effective in treating generalized anxiety disorder.⁴ Pregabalin, another medication in the gabapentinoid class, has been shown to be effective in treating anxiety disorders. This suggests that gabapentin may hold the potential for treating a spectrum of anxiety-related conditions beyond what is currently known.⁵

How Effective is Gabapentin for Anxiety?

Gabapentin’s effectiveness in treating anxiety symptoms varies from person to person. One study in the Journal of Clinical Psychopharmacology found that gabapentin significantly reduced symptoms of social anxiety disorder in a 14-week trial.⁶ Another study showed a significant improvement in anxiety symptoms for breast cancer survivors.⁷

It is important to note that individual responses to gabapentin can differ, and not everyone will experience the same level of relief. The dosage, duration, and specific type of anxiety disorder can influence its effectiveness. It is essential to work closely with a healthcare provider to determine the most suitable treatment plan based on an individual’s circumstances.

Is Gabapentin As Good as Xanax for Anxiety?

Gabapentin and Xanax (alprazolam) serve different roles in anxiety management and impact the body in different ways. Xanax is a benzodiazepine that functions by enhancing the effects of gamma-aminobutyric acid (GABA) in the brain. Xanax is FDA-approved for the treatment of anxiety disorders. It can be used long-term, but it is also effective in providing rapid relief for acute anxiety episodes. Comparing their effectiveness isn’t straightforward as they cater to different anxiety treatment needs, and individual responses to medications will vary.

How Quickly Does Gabapentin Work for Anxiety?

The time it takes for gabapentin to alleviate anxiety symptoms will vary from person to person. It may take a few days to several weeks for individuals to notice a reduction in their anxiety.

Several factors, including the prescribed dosage and the severity of anxiety symptoms, influence the duration it takes for the medication to exert its effects. Personalized adjustments and consistent communication with a healthcare provider are crucial in determining the right dosage and gauging the individual’s response to the medication.

How Long Do the Effects of Gabapentin Last?

The duration of gabapentin’s effects can vary based on factors such as dosage, individual response, and the purpose for which it is prescribed. The half-life of a medication is the time it takes for half of a medication to be eliminated from the body. The half-life of gabapentin is relatively short, around 5-7 hours in healthy individuals.¹

After 4-5 half-lives, there is not enough medication in the body to have a significant effect. Therefore, after 20-35 hours, gabapentin will have been cleared from the body. However, the effects on the brain will take longer to resolve fully.

Gabapentin for Anxiety Dosage

Since gabapentin’s use for anxiety disorders is considered off-label, there is no standardized recommended dose. However, dosages for off-label use generally fall within a broad range, and the precise dosage varies from person to person based on several variables. These variables can include an individual’s medical history, overall health, other medications being taken, and response to gabapentin.

It is important to emphasize that the symptom severity does not dictate the starting dosage of gabapentin. Instead, a healthcare professional will determine the appropriate dosage after considering each individual’s unique circumstances. The goal is to treat with an effective yet safe drug dosage to manage anxiety symptoms.

What Is the Best Time to Take Gabapentin?

Because of the short half-life of gabapentin, as discussed above, it is often prescribed to be taken 2-3 times per day. It is generally not recommended to go more than 12 hours between doses.² It is essential to follow the prescriber’s and pharmacist’s recommendations when taking gabapentin to achieve maximum benefit.

Do not abruptly stop taking this medication unless directed by your prescriber. Doing so may result in gabapentin withdrawal symptoms.

Can Gabapentin Be Taken at Night?

Gabapentin can be taken at night, and the timing of gabapentin administration often depends on an individual’s specific medical condition. For some, taking gabapentin at night can be beneficial, particularly if it is prescribed to manage conditions that interfere with sleep, such as certain types of pain or restless leg syndrome.³

What Does Gabapentin Feel Like for Anxiety?

Gabapentin’s effect on anxiety can vary from person to person. Some individuals may experience a sense of relaxation and reduction of anxiety symptoms. Gabapentin can produce a calming effect on the brain, potentially alleviating anxious thoughts and promoting an overall sense of tranquility.

Side Effects of Gabapentin for Anxiety

Gabapentin can cause side effects, though the side effects and their severity will vary from person to person. Side effects occur as a result of the drug’s effect on the body, often affecting various systems and functions. The most common side effects are mild and usually subside as the body adjusts to the medication. However, some side effects can be severe, requiring immediate medical attention.

Common side effects of gabapentin for anxiety include*:^{1, 8}

• Drowsiness
• Weakness
• Dizziness
• Incoordination
• Headache
• Diarrhea
• Dry mouth
• Constipation
• Nausea
• Vomiting
• Swelling of the hands, feet, ankles, or lower legs
• Weight gain

*All medications, including gabapentin, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Serious side effects of gabapentin for anxiety that require immediate medical attention include*:^{1, 8}

• Swelling of the face, throat, tongue, or lips
• Difficulty swallowing
• Difficulty breathing
• Seizures
• Suicidal thoughts and behavior

*All medications, including gabapentin, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

When taking gabapentin, some side effects are more common than others, and not everyone will experience them. Common side effects include fatigue, drowsiness, dizziness, and incoordination. Often, these symptoms will resolve as the body adjusts to the medication. However, immediate medical care may be needed if side effects become severe or persistent.

How to Get a Prescription for Gabapentin for Anxiety

Treatment for anxiety involves a thoughtful, multi-step process. For individuals struggling with anxiety symptoms, it is important to first contact your healthcare provider or a mental health professional. The clinician will conduct a thorough evaluation, assessing the nature and severity of anxiety symptoms, to determine the best course of treatment. One excellent option is using an online psychiatry service. These convenient online platforms allow individuals to connect with mental health professionals remotely, providing consultations and assessments via secure video calls.

Additional Strategies to Enhance Gabapentin Treatment for Anxiety

Taking medication for anxiety is just one part of the overall management. Integrating complementary strategies can be beneficial to enhance the treatment outcomes. Incorporating regular exercise and mindfulness practices can be helpful. Exercise helps release endorphins, body chemicals that help reduce anxiety and stress levels. Mindfulness techniques aid in promoting relaxation and mental clarity. Also, maintaining a consistent sleep schedule and a balanced, healthy diet can positively impact anxiety symptoms.

Other Treatments for Anxiety

There are many alternative treatment options for anxiety disorders. As gabapentin is not a first-line treatment, other medications and therapies will often be tried first. A comprehensive approach with various treatments is often the most effective. Treatment can include different types of therapy, including cognitive behavior therapy (CBT for anxiety) and exposure therapy. There are many other medications used in the treatment of anxiety disorders, including selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines.

As discussed above, lifestyle changes can also be beneficial when managing anxiety symptoms. Lifestyle changes may include regular exercise, a balanced diet, and sufficient sleep. Lastly, self-help strategies can be beneficial when managing anxiety symptoms. This may include joining support groups, either in-person or online therapy groups, which can provide a sense of community and understanding.

Other treatments for anxiety include:

• Selective serotonin reuptake inhibitors (SSRIs): SSRIs are medications commonly prescribed for mental health disorders, including anxiety and depression. They function by increasing serotonin in the brain, which helps to improve mood.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): SNRIs are medications also commonly prescribed for mental health disorders that function by increasing serotonin and norepinephrine in the brain, helping to improve mood.
• Benzodiazepines: Benzodiazepines are commonly prescribed for anxiety disorders. They work by increasing gamma-aminobutyric acid (GABA) in the brain, which provides a calming effect on the brain.
• Buspirone: Busprione is another anti-anxiety medication that impacts serotonin and dopamine. These are chemicals in the brain involved with mood regulation.
• Cognitive behavioral therapy: CBT for anxiety is a widely used therapy that aims to find practical solutions to the triggers and symptoms of anxiety.
• Exposure therapy: Exposure therapy is another commonly used and effective therapy for managing anxiety. It works by having clients address triggers in real and imagined ways, aiming to reduce symptoms.

Questions to Ask Your Healthcare Provider About Gabapentin for Anxiety

If someone is exploring the potential use of gabapentin for anxiety and is seeking more information, it’s essential to discuss this with their doctor, psychiatrist, or therapist. They should ask if gabapentin is a suitable option to address their specific anxiety symptoms. They may also want to ask about the function of gabapentin and its potential benefits, side effects, and drug interactions. Open communication with a healthcare professional ensures a comprehensive understanding of gabapentin’s role and helps to determine the most appropriate treatment plan.

Questions to ask your care team when considering the side effects of gabapentin may include:

• Can I use gabapentin along with therapy to treat anxiety?
• How long will it take for me to adjust to taking gabapentin?
• Am I at risk for more severe symptoms if I am already taking other anxiety /depression medications?
• What is the best dosage to ensure fewer side effects?
• Are there drugs I am taking that could have negative interactions?
• When should I reach out to you if I am experiencing side effects?
• Is there anything I should tell my therapist about this new medication?
• Are there lifestyle changes, such as diet and exercise, that can enhance the effectiveness of gabapentin?
• How often should I have follow-up appointments to monitor the effects?
• Are there any potential long-term effects of using gabapentin that I should be aware of?
• Should I avoid alcohol or certain activities when taking gabapentin?
• Can gabapentin affect my ability to concentrate or operate heavy machinery?

In My Experience

In my experience, gabapentin can be a very beneficial medication, and its usefulness goes beyond its currently FDA-approved uses. Gabapentin is not a medication that I prescribe frequently as a pediatrician. However, throughout my training, I have seen it prescribed for many uses, including anxiety, and have seen the positive impact it can have on patients’ lives. It is important to remember that numerous treatment options are available for anxiety, and if the initial medications don’t help, it’s essential not to lose hope.