Is Lyrica (pregabalin) effective for treating anxiety?

Does Lyrica Help with Anxiety?

Yes, pregabalin (Lyrica) is effective for treating generalized anxiety disorder (GAD) in adults and is considered a first-line treatment option alongside SSRIs and SNRIs. 1, 2

Regulatory Approval and Guideline Support

• Pregabalin is FDA-approved in Europe for the treatment of GAD in adults aged 7 years and older, demonstrating established efficacy for anxiety disorders. 1, 3
• The World Federation of Societies of Biological Psychiatry considers pregabalin a first-line agent for the long-term treatment of GAD, placing it alongside SSRIs and SNRIs. 1
• The American Academy of Child and Adolescent Psychiatry guidelines acknowledge pregabalin's FDA approval for GAD, though they note it is approved for treatment of diabetic neuropathy and postherpetic neuralgia as primary indications in the US. 4

Mechanism and Clinical Efficacy

• Pregabalin works through a distinct mechanism compared to traditional anti-anxiety medications: it binds to the α2δ subunit of voltage-gated calcium channels, reducing excitatory neurotransmitter release. 1, 3
• The drug demonstrates a rapid onset of anxiolytic effect, typically within 1 week or less, which is faster than SSRIs/SNRIs that may take 4-6 weeks. 1
• Pregabalin shows broad-spectrum activity against both psychic (psychological worry) and somatic symptoms (muscle tension, autonomic symptoms) of GAD. 1, 2

Long-Term Effectiveness

• In long-term studies, pregabalin maintained improvements in anxiety symptoms that occurred during short-term treatment. 1
• The medication delayed time to relapse of GAD compared with placebo in continuation studies. 1
• Pregabalin is effective for common GAD comorbidities including insomnia, gastrointestinal symptoms, and subsyndromal depression, with these conditions showing specific improvement during treatment. 1

Dosing and Treatment Considerations

• Effective doses for GAD range from 150-600 mg/day in divided doses, based on evidence from neuropathic pain studies that inform anxiety treatment. 4
• The drug requires dosage reduction in patients with renal insufficiency, with adjustments based on creatinine clearance. 4

Safety Profile and Important Caveats

Common adverse effects include:

• Dizziness and somnolence (dose-dependent, can be reduced by starting low and titrating slowly) 4, 1
• Weight gain 4, 1
• Peripheral edema 4

Critical safety concerns:

• Risk of dependence and withdrawal: While the potential for abuse is generally considered low, there is a growing number of reports regarding abuse or dependence, particularly in patients with a history of addictive behavior. 2, 4
• Discontinuation syndrome: Approximately 50% of patients prescribed pregabalin continuously for 12 months may experience withdrawal symptoms if stopped abruptly; the drug should be tapered gradually over at least 1 week. 4, 1
• Respiratory depression risk: When taken with opioids, pregabalin can cause dangerous respiratory depression through synergistic effects. 4

Evidence Gaps

• Definitive head-to-head studies comparing pregabalin with SSRIs/SNRIs are currently lacking, particularly in patients with GAD and comorbid major depressive disorder. 1
• One study showed positive results for SSRI/SNRI augmentation with pregabalin, though further investigation is warranted. 1
• A study examining switching from long-term benzodiazepine therapy to pregabalin was inconclusive, though some evidence suggests 15-29% of patients can stop benzodiazepines after starting pregabalin, with psychiatric patients showing a 48% reduction in benzodiazepine use. 5

Clinical Bottom Line

Pregabalin is an evidence-based, guideline-supported first-line treatment for GAD with rapid onset and effectiveness against both psychological and physical anxiety symptoms. However, prescribers must carefully weigh the benefits against risks of dependence, withdrawal, and dangerous interactions with opioids, particularly in patients with substance use history. 1, 2, 4