Gabapentin for Anxiety: Does it Work and Is It Safe?

Gabapentin (Neurontin), once a medication used strictly to manage seizures and nerve pain, has increasingly been used off-label to treat anxiety. From 2004 to 2022, annual gabapentin prescriptions increased from 18 million to 40 million, making it one of the most widely prescribed medications in the US \[1\].

It has a lower risk of abuse than benzodiazepines and may be beneficial when first lines of anxiety treatment, such as SSRIs or SNRIs, fail to work. Read on to understand what gabapentin is, how it works, and the effectiveness of using gabapentin for the treatment of anxiety.

What is Gabapentin, and What is It Used For?

Gabapentin is an anticonvulsant medication designed to treat seizures and nerve pain. It binds to the α2δ protein of calcium channels in the brain, reducing calcium influx into nerve cells and decreasing the release of excitatory neurotransmitters glutamate and norepinephrine. This helps calm nerve activity, reducing seizures and nerve pain. Gabapentin is FDA-approved and commonly prescribed for the following health conditions \[2\]:

• Epilepsy: Prescribed to both adult and child patients 3 years and older

• Postherpetic neuralgia (PHN): Nerve pain that occurs after a shingles infection

• Restless leg syndrome: Extended-release formula is approved for this

Gabapentin is also prescribed off-label for a range of conditions, including nerve pain from other causes such as diabetes or sciatica, hot flashes in menopausal women, and anxiety disorders.

Does Gabapentin Help With Anxiety?

Gabapentin is not an anxiety medication, but it is sometimes used off-label to manage physical anxiety symptoms such as increased heart rate, shakiness, panic attacks, and headaches. It helps relieve anxiety symptoms by reducing activity in the central nervous system. Detailed case studies show that gabapentin doses of >900 mg per day helped treat mild to moderate anxiety symptoms \[3\].

It is structured similarly to the neurotransmitter GABA, but does not mimic it exactly or act directly on the receptor like typical anxiety medications. Gabapentin is prescribed if first-line treatments such as SSRIs, SNRIs, or benzodiazepines are ineffective or not tolerated by the patient.

Gabapentin is less sedating, muscle-relaxing, and has a lower risk of addiction than benzodiazepines. They are also considered safer for long-term use due to their lower risk of dependence and overdose compared to benzos. They are sometimes used to help patients wean off long-term benzodiazepine use. Despite being less risky than benzodiazepines, they still carry a risk potential for abuse and should only be taken as prescribed, with caution \[3\]\[4\].

Is Gabepentin Addictive?

Although originally believed not to be addictive, recent evidence shows it can lead to addiction and withdrawal symptoms. The risk of Gabapentin addiction is higher in individuals with a history of substance use.

Gabapantin abuse is as high as 15% to 22% among opioid users, often used to enhance the euphoric effects of opioids. Both physical and psychological dependence can occur, and withdrawal symptoms of gabapentin include increased anxiety, insomnia, nausea, sweating, and in severe cases, seizures \[4\].

Gabapentin Interactions and Safety Considerations

Gabapentin is generally safe and can be prescribed to both children and adults with epilepsy. For the treatment of anxiety, it is often only used with adults in cases where other anxiety medications aren’t effective. Gabapentin carries several interactions and safety considerations, including \[5\]:

• Drug Interactions: Over 270 known drug interactions with varying severities. Common medications that can increase the risk of overdose when combined with gabapentin include opioids, benzodiazepines, antihistamines, and antacids that contain aluminum or magnesium. It’s important to speak with your doctor about any medication you are currently taking before starting gabapentin.

• Alcohol and Cannabis: These recreational drugs can increase the sedative effects of gabapentin, increasing the risk of serious impairment and overdose.

• Medical Conditions: Usually well-tolerated but should be avoided with some conditions, such as Myasthenia Gravis (MG).

Frequently Asked Questions About Gabapentin

More questions about the safety of Gabapentin? Below are a few common questions asked by patients who are on it.

Does Gabapentin lower blood pressure?

Gabapentin can lower blood pressure by reducing activity in the central nervous system in individuals with hypertension. In normal or non-hypertensive patients, gabapentin does not affect blood pressure.

Can you overdose on Gabapentin?

Yes, you can overdose on Gabapentin if you take more than the prescribed dose or mix it with other drugs such as benzodiazepines or opioids. The signs of gabapentin overdose include severe drowsiness or loss of consciousness, muscle weakness, dizziness, slurred speech, confusion, and slowed breathing.

How long does Gabapentin stay in your system?

The half-life of Gabapentin is about 5 to 7 hours, meaning it takes that amount of time for the concentration of Gabapentin in the bloodstream to reduce by half. To clear Gabapentin entirely from the body, it typically takes 25 to 35 hours.

Gabapentin Alternatives: Better Ways to Manage Anxiety

Although Gabapentin has a lower risk of addiction than benzodiazepines, there is still an abuse potential, and long-term use can contribute to several effects on mental and physical health. Below are some safer or alternative ways to manage anxiety instead of gabapentin:

Non-Addictive Anxiety Medication Alternatives:

• Amitriptyline: Tricyclic antidepressant sometimes used off-label for anxiety
• Antihistamines: FDA-approved for anxiety, used as a safer alternative to benzos
• Natural Supplements such as magnesium, ashwagandha, valerian root, or chamomile can be used as a natural alternative to manage anxiety symptoms and promote relaxation.

Non-Pharmacological Approaches:

• Individual therapy, such as Cognitive Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT), is an evidence-based treatment for a range of anxiety disorders.

• Group therapy gives patients with anxiety a safe space to share how they are feeling and connect with others who have similar struggles. This can reduce the shame sometimes that comes with having an anxiety disorder.

• Fitness, mindfulness, and stress management are helpful tools in the treatment of anxiety by triggering the release of “feel-good chemicals” in the brain, reducing muscle tension, and providing a distraction during anxious episodes.

• Holistic healing approaches such as yoga, meditation, massage, and acupuncture can improve emotional well-being and reduce physical symptoms of stress, such as stomachaches or migraines.

Comprehensive Anxiety Treatment at Northbound

For more than 30 years, Northbound Treatment Services in California has been at the forefront of providing lifesaving, compassionate residential care and specialized services to help people from all walks of life feel better, discover themselves, and live free from anxiety, addiction, and other mental health challenges.

We have facilities located throughout California to help guide you on your recovery journey. Reach out to our admissions team now.

Sources

Olesen, M. et al. 2025. Trends in gabapentinoid prescribing: A nationwide Danish drug utilization study. British Pharmaceutical Society Journals.

Catanese, L. 2024. Gabapentin: Uses, side effects, and what you should know if you’ve been prescribed this medication. Harvard Medical School.

Markota, M. et al. (2017). Treatment of Generalized Anxiety Disorder with Gabapentin. Case reports in psychiatry, 2017, 6045017.

Bonnet, U. et al. (2017). How addictive are gabapentin and pregabalin? A systematic review. European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology, 27(12), 1185–1215.