Pregabalin Can Cause Psychosis
Yes, pregabalin (Lyrica) can cause psychosis, particularly in vulnerable populations, even at low doses. The FDA drug label clearly documents cognitive impairment, confusion, and abnormal thinking as known adverse effects of pregabalin 1.
Neuropsychiatric Side Effects of Pregabalin
- Pregabalin commonly causes cognitive side effects including confusion (reported in 2-7% of patients), abnormal thinking (2-9%), and incoordination (2-6%) according to FDA data 1
- These cognitive effects are dose-dependent, with higher incidence at higher doses, but can occur even at therapeutic doses 1
- Pregabalin can cause delirium, particularly in vulnerable populations, similar to other CNS depressants 2
- Case reports document psychosis (hallucinations and delusions) occurring with pregabalin, even at doses as low as 25mg daily in susceptible individuals 3
Risk Factors for Pregabalin-Induced Psychosis
- Patients with dementia with Lewy bodies appear particularly susceptible to psychosis from even low doses of gabapentinoids 3
- Patients with pre-existing psychiatric conditions may be at higher risk 4
- Elderly patients are more vulnerable to neuropsychiatric side effects of medications in general 5
- Patients with a history of substance abuse may be at increased risk for both psychosis and developing dependence on pregabalin 4, 6
Mechanism of Action
- Pregabalin binds to the α-2-δ subunit of calcium channels, reducing calcium influx and decreasing neurotransmitter release 5
- This mechanism affects CNS function and can lead to various neuropsychiatric effects beyond the intended analgesic and anticonvulsant properties 7
- The drug crosses the blood-brain barrier and can directly affect brain function 7
Clinical Management
- If psychosis occurs with pregabalin use, the medication should be discontinued 3
- Withdrawal symptoms can occur with abrupt discontinuation, even at therapeutic doses, so tapering may be necessary 8
- Alternative medications for neuropathic pain include duloxetine, which has shown efficacy for diabetic peripheral neuropathy 5
- For patients who develop psychosis on pregabalin, consider alternative pain management strategies such as acetaminophen or carefully selected antidepressants 5
Important Considerations
- Pregabalin withdrawal can itself cause psychiatric symptoms including anxiety, insomnia, and in severe cases, hallucinations 8
- High doses of pregabalin have been associated with abuse potential and addiction 4, 6
- Patients should be monitored for neuropsychiatric symptoms when starting or increasing the dose of pregabalin 1
- The risk of psychosis must be weighed against the benefits for pain control, especially in patients with risk factors 5
In summary, pregabalin can indeed cause psychosis as documented in both the FDA drug labeling and case reports. This risk appears particularly pronounced in vulnerable populations such as the elderly, those with pre-existing neurological conditions like dementia with Lewy bodies, and those with a history of substance abuse.