Rankings / Mood, Anxiety & Stress
Gabapentin / pregabalin
Mood, Anxiety & Stress · alpha-2-delta voltage-gated Ca channel modulator
Tier B
Bottom line
Read Off Label grades Gabapentin / pregabalin as B (6.4/10) based on strong evidence, moderate benefit magnitude, and a med-risk safety profile.
Frequently used off-label for anxiety despite only pregabalin having formal GAD approval (in Europe).
Typical use: Gabapentin: 300-3600 mg/day divided; pregabalin: 150-600 mg/day divided — Rx.
What this is
Frequently used off-label for anxiety despite only pregabalin having formal GAD approval (in Europe). Growing recognition of abuse — particularly pregabalin in combination with opioids. Misleading narrative of 'non-habit-forming' has shifted as evidence of withdrawal syndromes accumulated.
Mechanism
Bind α2δ subunit of voltage-gated calcium channels; reduce neurotransmitter release (including glutamate, NE, substance P); not GABAergic despite GABA-mimetic name
Dose & route
Gabapentin: 300-3600 mg/day divided; pregabalin: 150-600 mg/day divided
Citations
- https://pubmed.ncbi.nlm.nih.gov/19160223/
- https://pubmed.ncbi.nlm.nih.gov/27372524/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC6178707/
- https://pubmed.ncbi.nlm.nih.gov/41142233/
- https://clinicaltrials.gov/study/NCT02120703
Links go to the source. If a link is dead or you want something re-checked, let me know.
Common questions
- Does Gabapentin / pregabalin work?
- Read Off Label rates the evidence for Gabapentin / pregabalin as Strong and the benefit magnitude as moderate, producing an overall grade of B (6.4/10). Frequently used off-label for anxiety despite only pregabalin having formal GAD approval (in Europe).
- Is Gabapentin / pregabalin safe?
- Gabapentin / pregabalin has a med risk profile in published human data. Legal status: Rx (pregabalin Schedule V US). This is not medical advice — see the disclaimer.
- What is the typical dose for Gabapentin / pregabalin?
- Gabapentin: 300-3600 mg/day divided; pregabalin: 150-600 mg/day divided
- How does Gabapentin / pregabalin work?
- Bind α2δ subunit of voltage-gated calcium channels; reduce neurotransmitter release (including glutamate, NE, substance P); not GABAergic despite GABA-mimetic name
This is an independent synthesis of published research by a non-clinician. Scores are opinions supported by citations, not prescriptions. See the full disclaimer and methodology for how this score was produced and what it does and doesn't mean.