What is the efficacy of Lyrica (Pregabalin) for anxiety disorders?

From the Guidelines

Lyrica is not the recommended first-line treatment for anxiety disorder, and instead, selective serotonin reuptake inhibitors (SSRIs) or venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI), are suggested. When considering treatment for anxiety disorders, it's essential to prioritize the most recent and highest quality evidence, which in this case, is the 2023 clinical practice guideline for social anxiety disorder from the Japanese Society of Anxiety and Related Disorders/Japanese Society of Neuropsychopharmacology 1. This guideline recommends SSRIs and venlafaxine as the primary pharmacotherapy options for social anxiety disorder in adults, with a weak strength of recommendation and low certainty of evidence. Some key points to consider when treating anxiety disorders include:

• The importance of selecting evidence-based treatments, such as SSRIs or SNRIs, as the initial pharmacotherapy approach
• Carefully evaluating the patient's specific symptoms, medical history, and potential interactions with other medications
• Monitoring patients for common side effects associated with SSRIs or SNRIs, such as gastrointestinal issues, sexual dysfunction, or changes in appetite or sleep patterns
• Considering alternative treatment options, like Lyrica, only after first-line treatments have been tried and found ineffective or not tolerated, due to its different mechanism of action and potential side effects.

From the Research

Lyrica for Anxiety Disorder

• Lyrica, also known as pregabalin, is a medication that has been approved for the treatment of generalized anxiety disorder (GAD) in adults 2.
• It has a distinct mechanism of action, which involves binding to presynaptic voltage-dependent calcium channels, leading to inhibition of excitatory neurotransmission 2.
• Studies have shown that pregabalin is effective in reducing anxiety symptoms in patients with GAD, with a rapid onset of action, typically within one week 2, 3.
• Pregabalin has been compared to other medications, such as sertraline, an SSRI antidepressant, and has been found to have a more rapid onset of action and equal efficacy 3.
• The medication is generally well-tolerated, with common side effects including dizziness, somnolence, and weight gain 2, 3.
• Pregabalin is considered a first-line agent for the long-term treatment of GAD, alongside SSRIs and SNRIs, by the World Federation of Societies of Biological Psychiatry 2.

Comparison to Other Medications

• A study comparing pregabalin to sertraline found that both medications were effective in treating GAD, but pregabalin had a more rapid onset of action 3.
• Another study found that SSRIs and SNRIs are effective in treating anxiety disorders, with higher doses of SSRIs associated with greater symptom improvement, but also increased likelihood of dropout due to side effects 4.
• Pregabalin has been found to be as effective as SSRIs and SNRIs in treating GAD, with a more rapid onset of action and equal efficacy 2, 3.

Efficacy and Tolerability

• Pregabalin has been found to be effective in reducing anxiety symptoms in patients with GAD, with a response rate similar to that of SSRIs and SNRIs 2, 3.
• The medication is generally well-tolerated, with common side effects including dizziness, somnolence, and weight gain 2, 3.
• Pregabalin has been found to have a low potential for abuse and a low risk of withdrawal symptoms when discontinued gradually 2.