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The use of gabapentin in bipolar disorder (BPD) treatment provides an informative case of off-label uptake and abandonment of a new medication. Gabapentin was patented by Warner-Lambert in 1977 and FDA-approved in December1993 for the adjunctive treatment of epilepsy and in 2002 for postherpetic neuralgia (see Appendix 1 for timeline). Clinical Points Gabapentin appears to have some benefit for anxiety disorders but failed to show benefit in bipolar disorder trials. In the individual patient with a mixed psychiatric disorder, benefits are most likely due to anxiolytic effects. Gabapentin has modest efficacy for alcohol craving and withdrawal symptoms and may have some benefit in opioid dependence as an adjunct therapy Gabapentin, a relatively new anti-epileptic drug (AED), is emerging as a therapeutic option for treatment refractory and rapid-cycling bipolar illnesses. Pharmacotherapy for bipolar disorders traditionally involves valproate, carbamazapine, or lithium, drugs which are associated with numerous adverse effects. Conversely, gabapentin has an attractive pharmacokinetics profile and relatively few Abstract Despite its prevalence and disease burden, several chasms still exist with regard to the pharmacotherapy of bipolar disorder (BD). Polypharmacy is commonly encountered as a significant proportion of patients remain symptomatic, and the management of the depressive phase of the illness is a particular challenge. Gabapentin and pregabalin have often been prescribed off-label in spite of Bipolar disorder (BD) Four DB-RCTs investigating the efficacy of gabapentin in BD were identified. 101 patients were randomised to receive gabapentin, 81 to placebo, 30 to lamotrigine and 19 to Issue: Most patients with a bipolar spectrum disorder are treated with 2 or more drugs in combinations that are sometimes rational and evidence-based and sometimes not. Key takeaways: Gabapentin is a medication that’s used to treat seizures, nerve pain from shingles, and restless leg syndrome. Despite previous marketing claims, there’s no evidence that gabapentin is a good treatment for bipolar disorder. The best treatment for bipolar disorder is therapy and a combination of other medications. These include mood stabilizers, anticonvulsants, and Gabapentin What is gabapentin treatment for bipolar disorder? Gabapentin is an anticonvulsant used primarily in the treatment of seizure disorders such as epilepsy. Anticonvulsant medications influence the actions of neurotransmitters leading to a decrease in brain cell (neuron) excitability. The gabapentinoids, gabapentin, and pregabalin, target the α<sub>2</sub>δ subunits of voltage-gated calcium channels. Initially licensed for pain and seizures, they have become widely prescribed drugs. Many of these uses are off-label for psychiatric indications, and there is increasing concern abou Two new anticonvulsants, lamotrigine and gabapentin, have been used increasingly for bipolar disorder in the past several years. Despite this array of options, bipolar disorder remains a difficult disorder to treat. Some subtypes, such as those characterized by rapid cycling or mixed episodes, have been especially resistant to lithium treatment. The gabapentinoids, gabapentin, and pregabalin, target the α2δ subunits of voltage-gated calcium channels. Initially licensed for pain and seizures, they have become widely prescribed drugs. Many of these uses are off-label for psychiatric Gabapentin may be a useful drug for the add-on treatment of bipolar patients with poor response to other mood stabilizers. Gabapentin may improve depressive residual symptoms such as irritability, social withdrawal or anxiety. These results should be confirmed in randomized clinical trials. Gabapentin is a nerve pain medication and anticonvulsant that has proven to be effective for people who have hard-to-treat depression or other mood disorders. Results: Gabapentin was moderately to mark-edly effective in 30% (15/50) of patients, with statistically nonsignificant differences between patients with bipolar disorder type I, bipolar dis-order type II and NOS, and unipolar major de-pressive disorder. 70% reported side effects, mainly sedation, with 16% of the total sample discontinuing treatment due to adverse events. Conclusion We identified 40 open-label studies on the use of GBP in at least 600 patients with bipolar disorder (BP), manic, depressed, or mixed episodes and unipolar depression and four controlled studies. Abstract Gabapentin is a new adjunctive medication to antiseizure therapies. Anecdotal evidence suggests that it may also help to alleviate mood symptoms in patients with bipolar illness. An open-label study examined the effects of adjunctive gabapentin in bipolar patients with mixed symptoms who had previously demonstrated only partial treatment responses. Mood ratings and side-effect Abstract Background: Gabapentin, a new anti-epileptic agent, has been anecdotally reported to be effective in the treatment of mania. We systematically assessed the response rate in bipolar patients being treated adjunctively with gabapentin for manic symptoms, depressive symptoms, or rapid cycling not responsive to standard treatments. Unfortunately, gabapentin does not demonstrate efficacy in randomized trials for bipolar disorder and current treatment guidelines do not emphasize its use. Despite of the lack of evidence, reviews of gabapentin prescribing patterns in the United States show that this medication is still being used with alarming frequency for bipolar disorder. Conclusion Gabapentin may be a useful drug for the add-on treatment of bipolar patients with poor response to other mood stabilizers. Gabapentin may improve depressive residual symptoms such as irritability, social withdrawal or anxiety. These results should be confirmed in randomized clinical trials. This article reviews evidence-based psychiatric uses of gabapentin, along with associated risks. An extensive literature review was conducted, primarily of articles searchable in PubMed, relating to psychiatric uses, safety, and adverse effects of
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