PsychRounds: The Psychiatry Podcast Gabapentin (Neurontin)
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Sep 17, 2025 Explore the intriguing rise of gabapentin, originally approved for seizures, now often used off-label in psychiatry. Delve into its contentious safety profile, revealing concerns about misuse and overdose risks, especially with opioids. Hear about its varied effectiveness in treating anxiety, alcohol use disorder, and even its limited role in bipolar disorder. The hosts break down the pharmacology behind this complex medication, discussing clinical implications and the evolving landscape of its use in mental health.
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Widespread Off-Label Prescribing
- Gabapentin is massively prescribed off-label with only ~1% used for FDA indications.
- The hosts highlight widespread off-label use in anxiety, alcohol use disorder, insomnia, and bipolar disorder.
Mechanism Is Calcium Channel Modulation
- Gabapentin does not act on GABA receptors despite its name; it targets alpha-2-delta-1 calcium channels.
- This mechanism likely reduces excitatory neurotransmitter release and may underlie anxiolytic and antiseizure effects.
Dose Low And Adjust For Kidneys
- Start gabapentin at low doses like 300–600 mg daily and titrate based on indication and tolerance.
- Watch renal function and adjust dose for GFR <60 because gabapentin is renally excreted unchanged.