Compulsive Behavior Risk with Lyrica (Pregabalin)
The available evidence does not indicate that pregabalin (Lyrica) causes compulsive behaviors; rather, it has been studied as a treatment to reduce compulsive symptoms in obsessive-compulsive disorder, with no reports of inducing compulsive behaviors as an adverse effect.
Evidence from Clinical Trials
The clinical trial literature examining pregabalin specifically addresses its use in treating compulsive behaviors rather than causing them:
Pregabalin was studied as an augmentation agent for treatment-resistant OCD in a randomized controlled trial listed in the Nature Reviews Disease Primers guideline, where it was compared to placebo for reducing obsessive-compulsive symptoms 1.
In a double-blind placebo-controlled trial, pregabalin augmentation led to significant reduction in compulsive symptoms, with 57.14% of patients showing >35% decline in Yale-Brown Obsessive Compulsive Scale scores compared to only 7.14% in the placebo group 2.
An open-label trial demonstrated substantial improvement in OCD symptoms when pregabalin (225-675 mg/day) was added to existing treatment, with good tolerability and no reports of worsening compulsive behaviors 3.
Mechanism of Action Context
Pregabalin's mechanism actually works against compulsive behavior development through its effects on neurotransmission:
The drug binds to α2δ subunits at presynaptic voltage-dependent calcium channels, leading to inhibition of excitatory neurotransmission 4.
Its hypothesized mechanism in OCD involves inhibition of glutamatergic neurotransmission, which is thought to reduce rather than promote compulsive symptoms 3, 2.
Known Adverse Effect Profile
The established adverse effects of pregabalin do not include compulsive behaviors:
Common side effects are dizziness, somnolence, and weight gain 4.
The drug has low abuse potential and low risk of withdrawal symptoms when discontinued gradually over 1 week 4.
Peak plasma levels occur approximately 1 hour after oral doses with 90% oral bioavailability, and the drug is not protein-bound with negligible hepatic metabolism 5.
Clinical Implications
When prescribing pregabalin, monitor for its known side effects rather than compulsive behaviors:
Watch for dizziness, somnolence, and weight gain as the primary concerns 4.
Discontinue gradually over at least 1 week to minimize withdrawal risk 4.
Consider pregabalin as a potential augmentation strategy in treatment-resistant OCD rather than avoiding it due to compulsive behavior concerns 2.
The probability of developing compulsive behavior with pregabalin appears to be zero based on available evidence, with the drug actually demonstrating efficacy in reducing such behaviors when they are present as part of OCD 3, 2.