Can Lyrica (pregabalin) cause mood swings?

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Can Lyrica (Pregabalin) Cause Mood Swings?

Yes, Lyrica (pregabalin) can cause mood swings and other neuropsychiatric effects, as documented in the FDA drug label which warns about the risk of suicidal thoughts and behavior, anxiety, and other mood changes.

Neuropsychiatric Effects of Pregabalin

FDA-Documented Mood Effects

Pregabalin has been associated with several neuropsychiatric effects that can manifest as mood swings:

  • Suicidal thoughts and behavior: The FDA drug label explicitly warns that antiepileptic drugs (AEDs), including pregabalin, may increase the risk of suicidal thoughts and behavior 1

  • Anxiety and mood changes: Patients taking pregabalin may experience:

    • Anxiety and panic attacks 2
    • Depression 1
    • Unusual changes in mood or behavior 1
    • Irritability 1
    • Agitation or restlessness 1

Mechanism Behind Mood Effects

Pregabalin's mood effects are likely related to its mechanism of action:

  • It binds to the alpha2-delta subunit of voltage-gated calcium channels 3
  • This binding reduces the release of excitatory neurotransmitters in the brain 3
  • These changes in neurotransmitter levels can affect mood regulation systems

Risk Factors and Monitoring

Higher Risk Populations

Some patients may be at increased risk for mood swings when taking pregabalin:

  • Patients with a personal or family history of depression 4
  • Patients with structural brain abnormalities 4
  • Patients on polytherapy with other medications that affect mood 4
  • Elderly patients 5

Monitoring Recommendations

To identify mood swings early:

  • Document baseline mental status before starting treatment 5
  • Monitor for emergence or worsening of depression symptoms 1
  • Watch for unusual changes in mood or behavior 1
  • Be particularly vigilant during the first 1-2 months of treatment 5

Managing Pregabalin-Related Mood Changes

Dose Considerations

  • Start with lower doses and titrate slowly to minimize side effects 2
  • Consider dose reduction if mood symptoms emerge 4
  • Avoid abrupt discontinuation, which can worsen mood symptoms 1

When to Seek Medical Attention

Patients should be advised to seek immediate medical attention if they experience:

  • Thoughts about suicide or dying 1
  • New or worsening depression 1
  • Extreme changes in mood or behavior 1
  • Aggressive behavior or anger 1

Positive Effects on Mood

Interestingly, pregabalin has shown some positive effects on mood in certain contexts:

  • Efficacy in treating depressive symptoms associated with Generalized Anxiety Disorder (GAD) 6
  • Low risk for depression (<1%) compared to some other antiepileptic drugs 4
  • Potential positive effect on mood in some patients 4

Clinical Perspective

When prescribing pregabalin, clinicians should:

  • Inform patients about the potential for mood changes
  • Advise family members to watch for mood changes that the patient may not recognize
  • Consider alternative medications if the patient has a history of mood disorders
  • Use monotherapy with slow titration schedules when possible to reduce the risk of mood disorders 4
  • Never discontinue pregabalin abruptly as this can trigger withdrawal symptoms including anxiety, insomnia, and other mood disturbances 1

In conclusion, while pregabalin is generally well-tolerated, mood swings are a recognized adverse effect that requires monitoring and appropriate management to ensure patient safety.

References

2
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Guideline

Medication Safety

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

6
Research

Efficacy of pregabalin in depressive symptoms associated with generalized anxiety disorder: a pooled analysis of 6 studies.

European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 2008

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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