Gabapentin: A Review of Published Experience in the Treatment of Bipolar Disorder and Other Psychiatric Conditions

Abstract

Successful therapy with valproate and carbamazepine in patients with psychiatric disorders led to investigation of other anticonvulsants for similar indications. Gabapentin is a relatively new anticonvulsant being investigated for potential use in the treatment of bipolar disorder (BD), anxiety disorders, behavioral dyscontrol, and substance use disorders. Its favorable side effect profile, absence of the need for therapeutic drug monitoring, and minimal drug interactions give gabapentin a potential role in these indications. Computer searches of the biomedical literature were undertaken to identify all pertinent case reports, case series, and studies of the drug as monotherapy or adjunctive therapy for BD; 10 reports were retrieved. In the treatment of various anxiety disorders, one study, one case report, and one case series were identified. At least one case series described gabapentin therapy for alcohol withdrawal and one case report of the drug for agitation associated with dementia. Published, well-designed studies evaluating the agent's effectiveness as monotherapy for BD are lacking. Its benefit as an adjunctive treatment with other mood stabilizers is also unestablished. Data regarding its efficacy in the treatment of anxiety disorders or manifestations of substance abuse are limited. These areas may deserve further investigation.

Gabapentin-Induced Worsening of Neuropsychiatric Symptoms in Dementia with Lewy Bodies: Case Reports

“…GBP has been recently investigated for potential use in the treatment of psychiatric disorders [3]. Uncontrolled trials reported that GBP may be an effective and well-tolerated treatment for behavioral and psychiatric symptoms in patients with dementia [4].…”

Examination of the Evidence for Off-Label Use of Gabapentin

“…Various authors of medical reviews on this subject have concluded that gabapentin should not be recommended for treatment of bipolar disorder and that double-blind, randomized controlled trials are needed to confirm any true efficacy of the drug in management of this condition. [18][19][20][21] Real-life practice involves instances of refractory bipolar disorder that exhaust the current treatment options. The Texas Medication Algorithm Project (TMAP) lists lamotrigine or gabapentin only as salvage therapy.…”

Cellular and molecular action of the putative GABA-mimetic, gabapentin

“…Gabapentin has been reported to be effective as therapy for bipolar disorders (for review see [33]) and social phobia [34]. Gabapentin has recently been described to improve sleep [35], suggesting yet another potential therapeutic use for this versatile compound.…”