Gabapentin for Anxiety: Uses, Benefits, and Side Effects

If you or a loved one experiences the excessive worry, restlessness, and muscle tension associated with anxiety, you’re not alone. Anxiety disorders are the most common mental health issue worldwide. While they’re treatable, not all treatments work for all people. If you’ve tried anxiety medications before, or if you have physical symptoms with anxiety, your doctor might suggest trying gabapentin.

Gabapentin ranks among the most frequently prescribed medications in the United States. While it isn’t FDA-approved for treating anxiety, it is sometimes prescribed off-label for treating anxiety.

In this article, we’ll go over what gabapentin is and how it’s used for anxiety. We’ll also discuss potential side effects and who should avoid using gabapentin for anxiety.

What is Gabapentin?

Gabapentin shares a similar structure to GABA, a calming neurotransmitter. But gabapentin doesn’t work in the body the same way that GABA does. Instead, it binds to subunits of calcium channels in the nervous system, reducing the release of excitatory neurotransmitters associated with pain and overactive nerves. Because of how gabapentin works, it was originally FDA approved to treat seizures and nerve pain.

Providers also prescribe gabapentin off-label for anxiety and fibromyalgia, among other conditions. An extended-release form of gabapentin called gabapentin enacarbi is FDA-approved for treating restless leg syndrome. 

Is Gabapentin Effective for Anxiety?

Most evidence for gabapentin in anxiety comes from small studies, case reports, and clinical experience rather than large randomized trials. However, this research has shown that gabapentin can be effective for anxiety. Most evidence supporting gabapentin’s effectiveness relates to:

• Generalized anxiety disorder (GAD)
• Social anxiety disorder (SAD)
• Performance anxiety
• Phobias
• Perioperative anxiety
• Panic disorder

Gabapentin is also sometimes used for people managing addiction, as it can help with opioid and alcohol cravings. 

The effectiveness of gabapentin can vary by person. But people who find it helpful say that it helps ease symptoms, regulate mood, and improve sleep quality. It’s often he

lpful for those with somatic symptoms of anxiety, such as a racing heart, muscle tension, and restlessness.

Because most of the information we have about gabapentin for anxiety is from clinical use rather than long-term research studies, it isn’t considered a first-line treatment for anxiety. Instead, doctors tend to prescribe selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) first.

These medications work differently than gabapentin by regulating serotonin and norepinephrine levels in the brain.

Keep in mind that treating anxiety isn’t always simple. There are many factors that contribute to anxiety, including family history, brain function, and lifestyle. It’s not unusual to try several treatments - or combinations of treatments - to find what works best for you. 

How Gabapentin is Used for Anxiety

In this section, we’ll go over dosing and what you can expect when starting gabapentin.

Typical Dosing and Scheduling

Your doctor will usually start you off on a low dose of gabapentin and then increase it gradually. This helps to prevent side effects. Unlike antidepressants, which are often taken once a day, gabapentin is taken in multiple doses throughout the day. Exact gabapentin dosage for anxiety varies and should always be determined by a healthcare provider.

How Long Gabapentin Takes to Work

Gabapentin can have short-term calming effects after a dose. However, consistent anxiety relief typically requires regular dosing over time. It can take 3-4 weeks to see the full benefits of gabapentin.

This is different from the way that SSRIs and SNRIs work. These gradually change your brain chemistry, so it can take 2-6 weeks to see symptom relief. 

Gabapentin Side Effects and Risks

Common side effects of gabapentin include:

• Drowsiness
• Dizziness
• Fatigue
• Dry mouth
• Headaches
• Nausea and stomach issues
• Unsteadiness
• Confusion and memory problems
• Changes in mood

While most side effects of gabapentin are mild, serious side effects can occur. Get medical help right away if you experience severe gabapentin side effects, including:

• Difficulty breathing
• Suicidal thoughts
• Blue-tinged fingers or lips
• Swelling of the face, neck, or throat

If you’re taking gabapentin, it’s important to not stop taking the medication or change your dose without guidance from a healthcare professional. This is because stopping gabapentin suddenly can cause withdrawal symptoms, including anxiety, insomnia, nausea, and increased heart rate. If you and your doctor decide that it’s best for you to stop taking gabapentin, they’ll guide you through how to safely taper your dose.

Gabapentin vs Other Anxiety Medications

Gabapentin works differently from other anxiety medications. Understanding how it compares to other options can help you understand why it may work better in some situations than others. 

Gabapentin is often recommended when:

• SSRIs and SNRIs haven’t worked or have caused side effects
• A non-benzodiazepine anxiety medication is desired due to dependence risk
• Anxiety is accompanied by sleep disturbances, restless leg syndrome, or nerve pain
• Short-term anxiety relief is needed while waiting for another medication to take effect

Who Should and Shouldn’t Use Gabapentin for Anxiety

Because gabapentin helps to calm nerve impulses, it can be helpful for people who have co-occurring conditions that gabapentin can treat alongside anxiety. This includes:

• Nerve pain
• Restless leg syndrome
• Seizure disorders

For people who have a history of substance abuse issues, important considerations should be made. While gabapentin is generally considered to have a lower misuse risk than benzodiazepines, tolerance and misuse have been reported, particularly with long-term or high-dose use. Gabapentin isn't usually recommended for people with respiratory issues. It's also not advised for those who are pregnant, breastfeeding, or planning to become pregnant. 

Gabapentin can increase sedation when combined with alcohol, opioids, benzodiazepines, or other central nervous system depressants.

Combining these medications may raise the risk of excessive drowsiness, slowed breathing, or overdose. Informing your doctor and pharmacist about all medications that you take can help them determine if gabapentin is safe for you.

When to Talk to a Healthcare Provider

If you have been taking gabapentin and aren’t noting any improvement in symptoms, let your doctor know.. They may recommend changing your dose or the timing of when you take the medication. It’s also important to get in touch with your healthcare provider if you are dealing with side effects from gabapentin. They might adjust your medication or recommend trying an alternative.

Takeaway

Gabapentin isn’t a first-line treatment for anxiety, but it can be used off-label to help manage anxiety. It can be especially helpful for people who haven’t found SSRIs or SNRIs effective or who also deal with nerve pain or sleep issues. If you’re considering taking gabapentin for anxiety, it’s important to talk with your healthcare provider. They can help weigh the benefits and risks of taking gabapentin, as well as monitor you throughout the process. 

Sources

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Markota, M., & Morgan, R. J. (2017). Treatment of generalized anxiety disorder with gabapentin. Case Reports in Psychiatry, 2017, 6045017. https://doi.org/10.1155/2017/6045017

Martin, J. C., & Gainer, D. (2022). Psychiatric uses of gabapentin. Innovations in Clinical Neuroscience, 19(7–9), 55–60. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9507147/

U.S. National Library of Medicine. (2020, May 15). Gabapentin. MedlinePlus. https://medlineplus.gov/druginfo/meds/a694007.html