How to Get Prescribed Gabapentin for Anxiety
Gabapentin is a prescription medication, so you get it through an evaluation with a licensed prescriber who decides whether it fits. For anxiety it is prescribed off-label, which means anxiety is not one of the conditions on the FDA label. PsychBright’s psychiatrists prescribe gabapentin when an evaluation finds it fits, by telehealth across California.
That is the short version of the process. The rest of this page covers what off-label means, what is and is not known about how the drug works, what the research says about anxiety in particular, and the things a prescriber checks before deciding. None of it is a promise that a prescription will be written, because the evaluation decides that.
What off-label means for gabapentin
The FDA label for gabapentin lists two uses. One is postherpetic neuralgia in adults, which is nerve pain that follows shingles. The other is adjunctive therapy for partial onset seizures, in adults and in children 3 and older. Anxiety is not on the label.
Prescribing a medication for a condition that is not on its label is legal and common. It is called off-label use. The point worth stating plainly is that off-label means the FDA has not approved gabapentin for anxiety.
What the label says about how gabapentin works
Some web pages describe a mechanism for gabapentin as if it were settled. The FDA label does not. It states that the precise mechanisms by which gabapentin produces its pain-relieving and antiepileptic actions are unknown.
What the label does report is narrower. Gabapentin is structurally related to GABA, a chemical messenger in the brain, but it has no effect on GABA binding, uptake or breakdown. It binds to a part of the voltage-activated calcium channels called the alpha-2-delta subunit. The label then says that the relationship between that binding and the therapeutic effects of gabapentin is unknown.
In plain terms, researchers know one place the drug binds and do not know how that relates to its effects. A page that says gabapentin “stabilizes nerve activity” is stating more than the label does.
Short-term anxiety and ongoing anxiety are different questions
The strongest research on gabapentin and anxiety is about a short-term situation: anxiety before a surgical procedure. A pooled analysis of trials found a reduction in that kind of anxiety, though its authors flagged wide variation between the trials and uncertainty about the estimate at the highest dose. The results came from single doses given before surgery, and anxiety was measured within hours. Separate research found that sedation increased with gabapentin given before surgery, so sedation is part of the effect that was measured.
That result says very little about treating an anxiety disorder that lasts months or years. A single dose before an operation and a long course of treatment for a condition like generalized anxiety disorder are different situations with different outcomes to measure. Anyone reading that gabapentin “reduces anxiety” should check which kind of anxiety, and which kind of study, the sentence is based on.
What the evidence for ongoing anxiety disorders looks like
The research base for chronic anxiety disorders is small, and it is easy to state in a few lines.
- Generalized anxiety disorder: no randomized trial of gabapentin exists.
- Social anxiety disorder: one placebo-controlled trial, with 69 people, published in 1999. No other placebo-controlled trial has repeated it.
- Panic disorder: one trial, with 103 people, published in 2000. It found no overall difference from placebo on its main measure.
The manufacturer’s research division was on the author line of both trials. That does not make the results wrong, and it is a fact a reader is entitled to know when weighing two small studies.
Where guidelines place gabapentin
Guidelines differ by condition, so each statement below is limited to the condition it concerns. The NICE guidelines do not list gabapentin for any anxiety disorder. Its social anxiety guidance says not to routinely offer anticonvulsants to adults with that condition.
Canadian guidelines place gabapentin as a second-line option for social anxiety disorder and a third-line option for panic disorder. It does not appear in their section on generalized anxiety disorder at all. Those are three different positions, and none of them can be stretched into a single statement about anxiety as a whole.
What an evaluation looks at before gabapentin is considered
The label itself contains several cautions, and each one is something a prescriber checks for during an evaluation.
- Other sedating medications and opioids. The label warns of respiratory depression, meaning slowed breathing, when gabapentin is combined with opioids or other central nervous system depressants, and in people with underlying breathing problems. Respiratory depression and sedation, sometimes resulting in death, have been reported with opioids.
- Substance use history. The label says misuse and abuse of gabapentin have been reported, mostly in people with a history of polysubstance misuse, and it tells prescribers to evaluate for a history of drug abuse. Research on misuse points the same way: the risk is concentrated in people who have other substance use disorders.
- Kidney function and age. Gabapentin is cleared almost entirely by the kidneys, so the dose is adjusted to kidney function. The label also advises care in dose selection for older adults for that reason.
- Pregnancy. The label asks patients to tell their prescriber if they are pregnant or planning to become pregnant.
- Mood. Gabapentin carries the warning that applies to the whole class of antiepileptic drugs, which covers suicidal thoughts and behavior. The label calls for monitoring mood for that reason.
Side effects, with the label’s real figures
The side-effect figures on the FDA label come from pooled trials in postherpetic neuralgia, in which 336 people took gabapentin and 227 took placebo. They are nerve-pain trials, not anxiety trials, so they describe the drug in a different group of patients. Each pair below shows gabapentin first and placebo second.
- Dizziness: 28% against 8%.
- Somnolence, meaning drowsiness: 21% against 5%.
- Peripheral edema, meaning swelling in the legs or feet: 8% against 2%.
In those trials, 16% of people on gabapentin stopped because of a side effect, against 9% on placebo.
The label also addresses driving. It says not to drive until you have enough experience with gabapentin to judge whether it impairs you, and it notes that a person’s ability to assess their own impairment can be imperfect. The duration of impairment is unknown.
Stopping gabapentin
Withdrawal symptoms have been seen in some people after they stop gabapentin, after both short and long treatment, usually within 48 hours. In people with epilepsy, stopping abruptly can also raise the risk of seizures. Because of both facts, stopping is something the prescriber plans with the patient. No taper schedule appears on this page.
How gabapentin is taken
This section describes the general shape and gives no instructions. Gabapentin can be taken with or without food. It is usually taken several times a day, and the dose is built up over days rather than started at its full level. The prescriber sets the amounts for each person, and none are listed here.
One interaction is worth knowing about. An antacid containing aluminum and magnesium reduced the absorption of gabapentin by about 20%, so the label says to take gabapentin at least two hours after such an antacid.
Frequently asked questions
Can I ask for gabapentin for anxiety?
You can raise it at an evaluation, and a prescriber will weigh it against your diagnosis, your other medications and your history. Whether it is prescribed is the prescriber’s decision. Anxiety is an off-label use, and the research for ongoing anxiety disorders is limited to the small set of trials described above.
Can I get gabapentin prescribed online?
PsychBright’s psychiatrists see adults 18 and older by video across California, and they prescribe gabapentin when an evaluation finds it fits. The appointment is an evaluation, and the prescriber decides after talking with you, because the checks listed above, such as other sedating medications and substance use history, need a conversation.
Is it hard to get prescribed gabapentin?
That depends on the evaluation, since the prescriber decides whether it fits. The prescriber looks at opioid use, any history of misuse, kidney function and pregnancy before deciding. For anxiety in particular, the limited evidence and the guideline positions above are part of that decision.
Does gabapentin actually help with anxiety?
It depends on which kind of anxiety is meant. The strongest evidence is for anxiety before surgery, from single doses with anxiety measured within hours, and sedation was part of that effect. For ongoing anxiety disorders there is no randomized trial in generalized anxiety disorder, one small trial in social anxiety and one in panic disorder that showed no overall difference from placebo on its main measure.
How long does gabapentin take to work for anxiety?
The research available gives no onset time for ongoing anxiety, so a number cannot be given here. The research that exists separates two cases. In the preoperative trials, anxiety was measured within hours of a single dose. For an ongoing anxiety disorder, that timing does not apply, and the prescriber is the right person to describe what to watch for.
What are the downsides of taking gabapentin?
From the label’s pooled nerve-pain trials: dizziness (28% against 8% on placebo), drowsiness (21% against 5%) and swelling in the legs or feet (8% against 2%). In those trials 16% stopped for a side effect, against 9% on placebo. Other downsides in the label include slowed breathing when combined with opioids or other sedating drugs, reports of misuse, and withdrawal symptoms after stopping, usually within 48 hours.
Can I take gabapentin only when needed for anxiety?
As-needed use for anxiety is not established in the available research. How a medication is taken is a decision for the prescriber, who sets the plan after an evaluation.
Which organ is gabapentin hard on?
The label says gabapentin is cleared almost entirely by the kidneys. For that reason the dose depends on kidney function, and the label advises care in older adults. That is a statement about how the drug leaves the body, and it is not a claim that gabapentin damages the kidneys.
Getting evaluated
If anxiety is affecting your daily life, the useful step is an evaluation, which looks at the whole picture before any single medication is chosen. PsychBright Health provides psychiatric evaluation and medication management by telehealth across California, to adults 18 and older, by video, usually within the same week.
If you are in crisis, do not wait for an appointment. Call or text 988 for the Suicide and Crisis Lifeline, or call 911 if someone is in immediate danger.