Sir: Gabapentin is a novel anticonvulsant that has been used in the treatment of epilepsy and, more recently, psychiatric disorders, including bipolar affective disorder, 1,2 behavioral dyscontrol, 3 and anxiety disorders. 4,5 We have had good results in using it to augment selective serotonin reuptake inhibitors in the treatment of obsessive-compulsive disorder (OCD), with few, and generally benign, side effects. We describe here a serendipitous finding: a patient with OCD and comorbid, long-standing severe alcohol dependency lost his craving for alcohol and stopped drinking precipitously without signs of withdrawal approximately 3 weeks after beginning treatment with gabapentin.Case report. Mr. A is a 38-year-old man with OCD, alcohol dependence, and history of amphetamine dependence. Mr. A's OCD symptoms, predominantly contamination fears of germs and resultant frequent hand washing, began at the age of 13 and have been severe. To avoid contact with "contaminated" objects, he frequently stayed in bed for most of the day. Since age 27, when he first entered treatment, he has been treated with maximum doses of sertraline, sertraline plus buspirone, fluoxetine plus clomipramine, clomipramine plus buspirone, paroxetine, and paroxetine plus olanzapine, with little symptom relief. He began abusing alcohol at age 21 and amphetamines at age 25, and these substances reportedly alleviated his OCD symptoms. Twelve years ago, he completed a 6-month alcohol treatment program, but relapsed soon afterward. He quit using amphetamines 1 1 /2 years ago, but continued to drink heavily, about a fifth of liquor a day. An attempt to wean him from alcohol by using clonazepam was unsuccessful owing to his continued alcohol craving. His medical history is significant for AIDS and hypertension.Seven months ago, we added gabapentin to augment the paroxetine OCD treatment. His other medications, taken for years, included hydrochlorothiazide and atenolol for hypertension, quaifenesin for sinus congestion, and anti-HIV medications (indinavir, zidovudine, and lamivudine). He was started on gabapentin, 300 mg b.i.d., for 1 week, then increased to 300 mg t.i.d. for 1 week, then 600 mg b.i.d. One month later, he returned to clinic and reported that, although he had no reduction in his hand-washing frequency, he was less avoidant of "contaminated" objects and also had more energy and motivation. Moreover, he had stopped drinking 10 days previously (2 1 /2 weeks after starting gabapentin), had experienced no symptoms of withdrawal, and had no craving for alcohol. He reported the alcohol cessation had not been planned, but rather was a result of a loss of alcohol craving since starting gabapentin treatment. His only gabapentin side effect was transient dizziness. At that time, we increased the gabapentin to 900 mg b.i.d. for 1 week, then 1200 mg b.i.d. One month later, he continued to be abstinent from alcohol and had no craving. He avoided "contaminated" objects even less, but washed his hands more frequently as a result of contact with these...
