From the Guidelines
Pregabalin is not recommended as a first-line treatment for anxiety and depression due to limited evidence supporting its efficacy and potential risks of dependence and withdrawal. The most recent and highest quality study, 1, published in 2023, suggests that for patients with symptoms of both depression and anxiety, treatment of depressive symptoms should be prioritized, and alternative treatments such as cognitive behavior therapy (CBT) may be used.
Key Points to Consider
- Pregabalin is primarily approved for neuropathic pain, fibromyalgia, and as an adjunctive therapy for partial seizures.
- For anxiety, pregabalin is only approved in some countries (not the US) for generalized anxiety disorder, typically at doses of 150-600mg daily divided into two or three doses.
- Common side effects of pregabalin include dizziness, drowsiness, weight gain, and cognitive impairment.
- Better options for anxiety include SSRIs (like sertraline or escitalopram), SNRIs (like venlafaxine), or benzodiazepines for short-term use.
- Depression is better treated with antidepressants such as SSRIs, SNRIs, or bupropion.
Recommendations
- Prioritize treatment of depressive symptoms in patients with symptoms of both depression and anxiety, as recommended by 1.
- Consider alternative treatments such as CBT for patients with anxiety and depression.
- Carefully monitor patients with a history of substance abuse when using pregabalin due to its potential risks of dependence and withdrawal.
From the Research
Efficacy of Pregabalin for Anxiety and Depression
- Pregabalin has been shown to be effective in treating generalized anxiety disorder (GAD) in adults, with a rapid onset of effect and broad spectrum activity against both psychic and somatic symptoms of GAD 2, 3, 4.
- Studies have demonstrated that pregabalin is effective in reducing anxiety symptoms, including in patients with severe anxiety and in those who have failed to respond to initial courses of antidepressant therapy 3, 5.
- Pregabalin has been compared to other treatments, such as sertraline, and has been found to have a more rapid onset of action and equal efficacy 5.
- The efficacy of pregabalin has been evaluated in various doses, with doses of 300-600 mg/day showing significant improvement in both psychic and somatic anxiety factors 6.
Safety and Tolerability of Pregabalin
- Pregabalin is generally well-tolerated, with common adverse events including dizziness, somnolence, and weight gain 2, 3, 4.
- The risk of withdrawal symptoms is generally low when pregabalin is discontinued gradually, and the potential for abuse is also low 2, 3.
- Pregabalin has been found to have a low potential for causing withdrawal symptoms, and tapering over the course of at least one week is recommended when discontinuing long-term therapy 3, 5.
Comparison to Other Treatments
- Pregabalin has been compared to benzodiazepines, which have been found to have greater somatic efficacy, while pregabalin shows greater efficacy for psychic anxiety 6.
- Pregabalin has been found to be effective in treating both psychic and somatic symptoms of anxiety, with a dose-response effect evident at doses of 300-600 mg/day 6.
- Pregabalin offers another treatment option for patients who do not respond to or who suffer intolerable adverse effects from other agents, such as SSRIs and SNRIs 2, 4.