Gabapentin and Anxiety: An Off-Label Use With Limited Evidence

What gabapentin is

MedlinePlus places gabapentin in a class of medicines called anticonvulsants. Neurontin is the current brand on DailyMed, and generics are widely available as capsules, tablets and a liquid. MedlinePlus notes that extended-release tablets are a separate product, used for restless legs syndrome, and cannot be swapped with other forms.

What is approved, and what is off-label

The Neurontin label lists two uses: management of postherpetic neuralgia, the lingering nerve pain after shingles, in adults; and add-on treatment of partial onset seizures in adults and children 3 and older with epilepsy. Anxiety is not an approved use.

Use for anxiety is off-label. A StatPearls chapter on NCBI Bookshelf lists anxiety disorders among off-label uses. A 2020 review in Frontiers in Psychiatry says gabapentin has been prescribed off-label for anxiety despite a lack of research evidence supporting that use.

The evidence that does exist is narrow. That review describes a small trial in social anxiety disorder, a trial in panic disorder that found a difference from placebo only in people with severe panic symptoms, a study suggesting possible help with anxiety related to public speaking, and several trials around surgery. StatPearls notes that one systematic review found no studies in generalized anxiety disorder specifically. A 2022 systematic review concluded that off-label psychiatric prescribing of these medicines was not supported by robust evidence except for some anxiety states.

For a wider view, read about anxiety medicines other than benzodiazepines, or see how online anxiety treatment works here.

How it is thought to work

Despite the name and its structural link to the brain chemical GABA, the label says gabapentin has no effect on GABA binding, uptake or breakdown. It binds strongly to a part of voltage-activated calcium channels known as the alpha-2-delta subunit, but the label says how that relates to its effects is not established. The precise way it works is unknown.

What taking it can be like

The label describes drowsiness, dizziness and problems with coordination as effects to watch for. It warns that you may not be able to judge your own impairment accurately. It says not to drive until you have had enough experience on gabapentin to know whether it impairs you, and that driving impairment may be significant.

MedlinePlus says antacids such as Maalox or Mylanta should be taken at least 2 hours before gabapentin tablets, capsules or liquid. A pharmacist can check your other products.

Side effects and warnings

Gabapentin has no boxed warning on the Neurontin label. These warnings are the ones to know.

• Suicidal thoughts: antiepileptic medicines, including gabapentin, increase the risk of suicidal thoughts or behavior for any use. Watch for new or worse depression, unusual mood or behavior changes, and tell your prescriber right away. If you have thoughts of harming yourself, call or text 988, or call 911.
• Breathing: serious, life-threatening or fatal respiratory depression has been linked to gabapentin taken with opioids or other sedating medicines, or in people with lung or breathing problems. Call 911 for trouble breathing, bluish lips or skin, confusion or extreme sleepiness.
• Severe reactions: anaphylaxis and swelling can occur after the first dose or later, and a multiorgan reaction called DRESS has occurred, which can involve fever, rash and swollen glands. Seek care immediately.
• Common effects on the label: dizziness, sleepiness and swelling of the legs or feet in adults with nerve pain; sleepiness, dizziness, poor coordination, fatigue and unusual eye movements in people with epilepsy. MedlinePlus also lists headache, double vision, nausea and weight gain.
• Children: the label notes emotional changes, hostility and concentration problems in children 3 to 12 with epilepsy.

Stopping, misuse and controlled status

Do not stop gabapentin suddenly. MedlinePlus says withdrawal symptoms can include anxiety, trouble sleeping, nausea, pain and sweating. The label says abrupt or rapid discontinuation may raise the risk of seizures, and that suicidal thoughts have also been reported after discontinuation.

The label says gabapentin is not a controlled substance. It also reports misuse and abuse in the postmarketing setting, mostly among people with a history of polysubstance use, and tells prescribers to evaluate that history. The 2020 review says scheduling may vary between states, so ask your pharmacist or prescriber about the rules where you are. If you are pregnant, planning a pregnancy or breastfeeding, tell your prescriber.

Can gabapentin be managed online in Pennsylvania and New York

The label does not limit gabapentin to a clinic. Your prescriber will still need an accurate picture of your kidneys, lungs and other medicines, and a video visit depends on what you share and on records. Because this is an off-label use, ask what evidence applies to your situation. Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help, using our medication inquiry form.

A licensed psychiatrist on our team treats anxiety by secure video for people physically located in Pennsylvania or New York during each visit. See online psychiatry in Pennsylvania and our medicines list. Our therapists do not prescribe, and they see clients in Pennsylvania, West Virginia, Arizona, Colorado and Florida, not New York. Ask us about fees and insurance.

If you are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services.