Pregabalin Uses in Psychiatry
Pregabalin is primarily used in psychiatry for the treatment of generalized anxiety disorder (GAD), social anxiety disorder (SAD), and as an adjunctive therapy for management of anxiety symptoms in patients with various psychiatric conditions.
Primary Psychiatric Indications
Generalized Anxiety Disorder (GAD)
- Pregabalin has demonstrated significant efficacy in treating GAD with a rapid onset of effect (typically ≤1 week) 1
- Shows effectiveness against both psychic and somatic symptoms of anxiety 1
- Peak reduction in anxiety symptoms occurs at approximately 450 mg/day 2
- For psychic anxiety symptoms: optimal dose around 400 mg/day
- For somatic anxiety symptoms: continued efficacy increase up to 600 mg/day
Social Anxiety Disorder (SAD)
- Effective for generalized SAD at doses of 450-600 mg/day 3
- Recommended as a first-line drug in the Canadian Clinical Practice Guideline 4
- Particularly valuable for patients who cannot tolerate or show lack of efficacy with SSRIs/SNRIs 3
Dosing and Administration
- Starting dose: 75 mg twice daily 5
- Target dose: 300 mg daily (can be titrated as needed) 5
- Maximum recommended dose: 600 mg daily 5
- Dosing schedule: 2-3 times daily 5
- Titration: Faster than gabapentin (days vs. weeks) 5
Efficacy in Special Populations
- Elderly patients (≥65 years): Demonstrated safety and efficacy for GAD at doses of 150-600 mg/day 6
- Shows early onset of action (by 2 weeks)
- Improves both psychic and somatic anxiety symptoms
Safety and Adverse Effects
Most common adverse effects:
Safety considerations:
Long-term Treatment
- Maintains improvements in anxiety symptoms with continued treatment 1
- Delays time to relapse compared with placebo 1
- Generally well-tolerated in long-term treatment (1 year) 8
- Dizziness (12.5%) is the most common treatment-related adverse effect in long-term use
- Few severe treatment-related adverse events (5.1% in anxiety disorders overall)
Special Considerations
- Requires gradual tapering to prevent withdrawal symptoms 5
- Dose adjustment needed in patients with renal impairment 5
- Considered a first-line agent for long-term treatment of GAD by the World Federation of Societies of Biological Psychiatry 1
- May be used as add-on therapy to augment pharmacotherapy or in addition to cognitive-behavioral therapy for anxiety disorders 3
Monitoring Recommendations
- Assess efficacy after 3-8 weeks of titration plus 2 weeks at maximum dose 5
- Monitor for adverse effects at each dose increase, particularly dizziness, somnolence, and weight gain 5
- Regular monitoring of renal function in long-term use 5
Pregabalin offers a distinct mechanism of action compared to other anxiolytics, making it a valuable option for patients who don't respond to or cannot tolerate traditional first-line treatments like SSRIs or SNRIs.