Repurposing Gabapentin for Social Anxiety Disorder: A Case Series Study Proposal
A case series study examining the efficacy of gabapentin for social anxiety disorder in psychiatric outpatients would be an excellent, clinically relevant topic that can be completed within 1.5 months and leverages drug repurposing.
Rationale for Topic Selection
Gabapentin represents an ideal candidate for repurposing in social anxiety disorder (SAD) for several reasons:
Established mechanism: Gabapentin binds to the α2δ subunit of voltage-gated calcium channels, potentially reducing anxiety by decreasing excitatory neurotransmitter release 1.
Clinical gap: Current guidelines recommend SSRIs/SNRIs as first-line treatments for SAD, but these medications have limitations including delayed onset of action and side effects 2.
Preliminary evidence: While pregabalin (structurally similar to gabapentin) is recommended as a first-line treatment for SAD in some guidelines 2, gabapentin has limited research despite potential benefits and lower abuse potential 3, 4.
Study Design Framework
Patient Selection
- 8-12 adult outpatients (ages 18-65) with DSM-5 diagnosed social anxiety disorder
- Moderate to severe symptoms as measured by Liebowitz Social Anxiety Scale (LSAS) score ≥60
- Patients who have either not responded to or cannot tolerate SSRIs/SNRIs
- Exclude patients with substance use disorders, bipolar disorder, or psychotic disorders
Intervention Protocol
- Starting dose: 300mg gabapentin daily
- Titration: Increase by 300mg every 3 days as tolerated
- Target dose: 900-1800mg daily in divided doses (based on response and tolerability)
- Duration: 4-week treatment period with baseline and weekly assessments
Outcome Measures
- Primary: Change in LSAS score from baseline to week 4
- Secondary:
- Clinical Global Impression-Improvement (CGI-I) scale
- Social Phobia Inventory (SPIN)
- Quality of life assessment (SF-36)
- Treatment-emergent adverse effects
Implementation Timeline
| Week | Activities |
|---|---|
| Week 1 | Patient screening and enrollment, baseline assessments |
| Week 2-5 | Medication administration, weekly assessments |
| Week 6 | Data analysis and report preparation |
Clinical Relevance and Feasibility
This study addresses several important clinical needs:
Alternative treatment option: For the 30-40% of SAD patients who don't respond to first-line treatments 2.
Rapid onset potential: Gabapentin may provide faster symptom relief than SSRIs, which typically take 4-6 weeks for full effect 4, 5.
Favorable side effect profile: Gabapentin has minimal drug interactions and doesn't require therapeutic drug monitoring 6.
Accessibility: Gabapentin is widely available as a generic medication, making it cost-effective.
Potential Pitfalls and Considerations
Sample size limitation: While a case series with 8-12 patients is feasible within the timeframe, it limits statistical power.
Placebo effect: Without a control group, placebo effects cannot be ruled out.
Medication adherence: Monitor adherence carefully as gabapentin requires multiple daily doses.
Abuse potential: Though lower than pregabalin 7, monitor for signs of misuse.
Dosing considerations: Gabapentin has non-linear absorption, with bioavailability decreasing at higher doses 8.
Documentation and Reporting
- Document detailed case histories, including previous treatment responses
- Photograph standardized assessment forms for verification
- Record all adverse events systematically
- Present findings as both individual case reports and aggregate data
- Include representative case vignettes to illustrate response patterns
This study design is practical, clinically relevant, and achievable within the 1.5-month timeframe while addressing an important gap in treatment options for social anxiety disorder.