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The gabapentinoids, gabapentin, and pregabalin, target the α2δ subunits of voltage-gated calcium channels. Initially licensed for pain and seizures, they have become widely prescribed drugs. Many of these uses are off-label for psychiatric Risk factors for having a combination of depression and anxiety include older age and greater severity of anxiety symptoms. 80 Although most RCTs of anxiety exclude depressive disorder diagnosis from entry, open-label use of citalopram showed a significantly lower rate of response in patients with comorbid anxiety and depression versus either Generalized anxiety disorder (GAD), a chronic illness [1,2], often begins during adolescence or early adulthood [3,4], and persists throughout the lifespan . Characterized by pervasive, diffuse anxiety related to multiple domains, GAD affects up to 5% of children and adolescents and between 3–6% of adults. This review will focus on the comparative properties of gabapentin and pregabalin, specifically the available evidence on their use in the treatment of primary anxiety disorders — GAD, social anxiety disorder, panic disorder, and obsessive-compulsive disorder. Our preliminary observations suggest a role for gabapentin as monotherapy or for adjunctive use in patients with panic disorder or generalized anxiety disorder. The promising preliminary results encourage further clinical exploration and systematic study of gabapentin for the treatment of anxiety disorders. Anxiety disorders are the most prevalent psychiatric disorders and a leading cause of disability. While there continues to be expansive research in posttraumatic stress disorder (PTSD), depression and schizophrenia, there is a relative dearth of novel medications under investigation for anxiety disorders. This review’s first aim is to summarize current pharmacological treatments (both There are currently no known ongoing trials of gabapentin for anxiety disorders. Another anticonvulsant, tiagabine, is FDA-approved for the treatment of partial seizures and has been shown to have potential anxiolytic effects in preclinical studies . Previously presumed to have a low abuse and misuse potential, gabapentin has been commonly prescribed for the treatment of anxiety disorders. 10,11 While pregabalin has shown efficacy for generalized anxiety disorder (GAD) in two RCTs, 12,13 the authors could find no such RCTs done for gabapentin. 9 One randomized, double-blind, placebo-controll Gabapentin in the treatment of anxiety and depression: Gabapentin is sometimes prescribed off-label for patients with bipolar disorder to reduce anxiety levels or for anxiety disorders. Clinicians have also used it for patients who have anxiety and depression. That said, if one can do as well or better with agents or methods less fraught with concerns, it would be a most reasonable decision. Now, 40 years from my first perspective publication on benzodiazepines (), I work at a center for the treatment of anxiety disorders, the majority of which is staffed by brilliant and highly skilled psychologists trained in cognitive-behavioral therapy (CBT). Prescription rates for gabapentinoids are rising in England. Pregabalin is currently recommended by NICE for the treatment of anxiety. Gabapentinoids have some overlap with the action of benzodiazepines, and have similar issues with tolerance, dependence, addiction and withdrawal. They were schedule Evidence for the use of pregabalin in anxiety is derived from short-term trials, with marginal differences from placebo, which do not take into account the longer term effects of tolerance, dependence and withdrawal. Conditional anxiety b: 300-1200: Change in STAI, visual analogue scale, or verbal anxiety score: Gabapentin better than placebo at 4 wk (P = .005) and 8 wk (P < .005) for postchemotherapy Gabapentin better than hydroxyzine (P = .023) and placebo for perisurgical anxiety, no different from melatonin: Yes: 40: 1: OCD: 600-900: Change in Y-BOCS A clear pattern of remission or mild anxiety on total daily doses of gabapentin ≥ 900 mg/day and severe anxiety at doses < 600 mg/day was observed. In the absence of randomized controlled trials, these findings may offer clinically important clues about dosing and effectiveness of gabapentin in GAD. Gabapentin is frequently used in the treatment of anxiety disorders. However, there are no randomized controlled trials on the effectiveness of this medication in generalized anxiety disorder (GAD), and there are only a few case reports. On the basis of the evidence supporting pregabalin, it has been suggested that gabapentin, an older GABA analog with similar structure and mechanism of action, may also effectively treat generalized anxiety disorder. A third study found that gabapentin may help with anxiety related to public speaking . There are also several trials of gabapentin showing efficacy in perioperative anxiety . Gabapentin has similar adverse effects as pregabalin including sedation, dry mouth, constipation, weight gain, and pedal edema. Gabapentin was licensed for use in the UK in 1997 and pregabalin in 2004. The initial indication was for seizure disorders, but gabapentin and pregabalin (the gabapentinoids) are now also licensed for neuropathic pain, and pregabalin for generalised anxiety disorder (GAD) as second-line treatment in the current NICE guidelines (NICE, 2011). Based on the pharmacology of gabapentin, a relationship between exposure and anxiety was hypothesized and specified a priori in the design of a double-blinded, placebo-controlled trial of gabapentin for the treatment of hot flashes in breast cancer patients: Gabapentin for the Control of Hot Flashes in Women with Breast Cancer (ClinicalTrials On the basis of the evidence supporting pregabalin, it has been suggested that gabapentin, an older GABA analog with similar structure and mechanism of action, may also effectively treat generalized anxiety disorder.
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