Anxiety gabapentin

For anxiety, gabapentin is a second-line treatment to augment SSRIs, SNRIs, or benzodiazepines... 

Gabapentin, a non-benzodiazapine GABA analog, was modestly effective in a 14-week controlled trial in SAD. Most patients were titrated to a maximal dose of 3600 mg/day.58 Pregabalin 600 mg/day was effective for social anxiety, fear, and avoidance behavior in a 10-week controlled trial.63 Pregabalin was well tolerated, and the most common side effects were somnolence and dizziness. 

Social anxiety disorder Escitalopram Fluvoxamine Paroxetine Sertraline Venlafaxine XR Citalopram Clonazepam Buspirone Gabapentin Miitazapine Phenelzine Pregabalin... 

A single controlled study of gabapentin demonstrated modest effectiveness. A high gabapentin dose, 3600 mg/day, was required to achieve this modest degree of success. Similarly, high dose pregabalin (600 mg/day) was effective in a recent controlled study for social anxiety disorder. 

In addition to treating insomnia, gabapentin has been used to treat epilepsy, anxiety disorders, and bipolar disorder. It is generally well tolerated with sedation and headaches being the only prominent side effects. Because gabapentin is excreted unchanged in urine, it does not require metabolism by the liver. It is therefore easily eliminated by elderly patients and those with liver disease, although it should be used with caution in those with poor renal (kidney) function. 

Gabapentin acts by increasing GABA activity, although its exact mechanism of action is unclear. It causes dose-related sedation and dizziness. It has been shown in randomised controlled trials to be effective in social anxiety disorder (Pande et al. 1999) and to benefit some patients with panic disorder (Pande et al. 2000). Pregabalin is a related compovmd that has recently demonstrated efficacy in GAD in a phase III study (Pande et al. 2003). 

BZs should be reserved for patients at low risk of substance abuse, those who require rapid relief, or those who have not responded to other therapies. Clonazepam is the most extensively studied BZ for treatment of generalized SAD. It improved fear and phobic avoidance, interpersonal sensitivity, fears of negative evaluation, and disability measures. Adverse effects include sexual dysfunction, unsteadiness, dizziness, and poor concentration. Clonazepam should be tapered at a rate not to exceed 0.25 mg every 2 weeks. Gabapentin was effective for SAD, and onset of effect was 2 to 4 weeks. j8-Blockers blunt the peripheral autonomic symptoms of arousal (e.g., rapid heart rate, sweating, blushing, and tremor) and are often used to decrease anxiety in performance-related situations. For specific SAD, 10 to 80 mg of propranolol or 25 to 100 mg of atenolol can be taken 1 hour before the performance. A test dose should be taken at home on a day before the performance to be sure adverse effects wUl not be problematic. Incomplete response to a first-line agent may benefit from augmentation with buspirone or clonazepam. 

It all else tails for anxiety disorders, consider gabapentin or tiagabine... 

Usually administered as adjunctive medication to benzodiazepines, SSRIs, and/or SNRIs in the treatment of anxiety disorders and to SNRIs, gabapentin, other anticonvulsants, and even opiates in the treatment of chronic pain... 

Two cases of gabapentin-related dyskinesia have been reported (19). The patients were 60 and 41 years old and took gabapentin 900-1200 mg/day for generalized anxiety. Generalized dyskinetic movements and facial tics appeared after 3 days and disappeared after 2 days of withdrawal. 

Drug withdrawal Insomnia, anxiety, sweating, headaches, and symptoms of palpitation progressed over 2 days after inadvertent withdrawal of therapeutic doses of gabapentin in a 41-year-old man with an orthotopic liver transplant. After the drug was restarted, his symptoms slowly improved over the next 24 hours [169 ]. 

Abrupt discontinuation and withdrawal of gabapentin may precipitate seizure (status epilepticus). The most frequently reported events following abrupt discontinuation were anxiety, insomnia, nausea, pain, and sweating. 

Chorea in an elderly patient with anxiety resolved completely after gabapentin was withdrawn [115 ]. 

---