GABAPENTIN

Is it really so helpful and relatively harmless?

Chances are you or someone you know has been prescribed Gabapentin or its brand name Neurontin. In any room full of people, its likely that 1or 2 have been prescribed Gabapentin within the last year.

As a licensed Marriage and Family Therapist, I see individuals in my practice who range from ages 10-70 and it is astounding to me not only how many have been prescribed Gabapentin but also what they have been prescribed it for.

When I first heard of Gabapentin years ago, it was prescribed to me for nerve pain I was suffering as a result of a traumatic injury I had had years earlier. What I have come to learn since then is that Gabapentin can be prescribed for relatively simple issues such as improving sleep or decreasing general aches and pains and it can also be prescribed to treat more complicated conditions such as seizures, sciatica, restless legs, and fibromyalgia- just to name a few of the myriad conditions across many different "categories". For one client battling alcoholism, it was prescribed to her to reduce her cravings; another client took it to provide emotional and physical relief while withdrawing from Subutex.

I had a client who was prescribed Gabapentin for mood regulation and anxiety. It was given to another client post-op as a positive alternative to stronger more addicting pain medications such as opioids. A client was recommended it when he went to his doctor for a sinus infection. It is used often as an anticonvulsant or an anti-seizure medication.

And it’s not just humans who take Gabapentin. One of my clients reported his cat was given a prescription to relieve its apparent stress during the aftermath of the Montecito floods while another client’s dog took Gabapentin to treat incontinence and muscle weakness.

This is just the tip of the iceberg and I could go on and on… and on. But you are probably getting my point: Gabapentin is ubiquitous and seems to be a go-to medication for many physicians as of late.

In addition to how commonly it is prescribed, nearly all of my clients share some version of the same story that their physicians have informed them that Gabapentin is a medication that has “been around for a long time and there are few negative side effects other than drowsiness and grogginess.”

Now- before I go any farther, I want to provide a critical caveat: I am not a physician and therefore, I am not an expert or qualified to prescribe medication. My father was a physician who specialized in internal medicine as well as cardiology and nephrology. He prescribed medications; therapists do not. I respect the importance of being trained for the position you hold and I find it frightening that we now live in a world where anyone can write anything, post it on the internet, and portray themselves as experts so I don’t want to mislead anyone into thinking that I am claiming to be an expert on medications.

As a therapist, we are held to a standard both legally and ethically to stay both within our “scope of practice” and our “scope of competence”. Neither of my scopes are medication and I want to be clear that I am NOT recommending nor discouraging Gabapentin or any other medication in my writing. To be crystal clear: I know Gabapentin has been lifechanging and instrumentally helpful for some people so I am not discouraging its use.

However, I also want to report on the data my clients present to me of their lived experiences. And what that lived experience has been is far different from experiencing “grogginess or drowsiness”.

The side effects I have heard my clients report consistently from being on Gabapentin are that they feel they are losing their mind. They feel forgetful; they can't think of words when they are speaking or writing; they feel stupid; they feel slow or like their brains are just not firing; they feel out of it. They feel they aren't functioning like they used to. Moms aren't remembering their children's pick-up schedules or their duties at their workplaces; dads are feeling irritable, losing their patience with their families and at work. And when they have reported these side effects to their physicians, they have often been instructed to increase the dosage or been told that it can take time for the medication to kick in.

It was explained to me by a few different physicians that Gabapentin works in multiples of threes. A patient might start with 300mg three times a day and if that isn’t working, it can be increased to 600mg three times a day. Many doctors use a typical dosage range of 900mg -1800mg a day but other doctors have reported to me that they prescribe as high as 3600 mg/day. 

When my clients are already taking 3 pills/day and feeling off and not like themselves, they have reported their doctors instruting them to take 6 pills/day and they feel fearful that now they are taking 6 pills or even up to 9 pills and being told to wait it out and hope things will start to feel better soon.

Several months ago, a woman called me and asked if I was accepting new clients. I asked her for a little more background information about what she was looking for in a therapist and what she was struggling with. She told me she had gotten into a new relationship and the first month had been wonderful but she had been feeling off and was worried she was sabotaging this new relationship. She said she had always struggled with low self-worth but she had been really happy with her job and her new relationship until she noticed feeling irritable and reacting in ways she felt were out of character. It was only after a conflict that she could she look back and realize she had hugely overreacted. I went down her medication list and she informed me she had thrown out her back and had taken Gabapentin for the pain for a few weeks, didn't like how she felt on it, and stopped "cold turkey". When I heard her describing that she didn’t feel like herself; she was overreacting, and acting out of character, her story overlapped with other clients I have had who have either been taking Gabapentin or coming off Gabapentin and expressed practically identical feelings.

Another recent case is a client in her 70s who I have seen for several months but recently had shingles and was prescribed Gabapentin. She reported to me over two sessions that she felt she was losing her mind. She felt she was forgetting everything and started panicking that she was starting to get dementia. I suggested she talk to her doctor about the possibility of these symptoms being a side effect from the Gabapentin since she had not shown any symptoms of dementia until that point. She came back the third week and reported that her doctor said he doubted the Gabapentin was causing these symptoms, but she told him she wanted to stop the Gabapentin anyways. It has now been six weeks and she reports she feels like herself again.

A client in her mid 30’s who I had been seeing about work stress started expressing to me that her husband was acting distant lately and she couldn’t really put her finger on it. She felt he was more irritable with her and the kids. This wasn’t something we usually focused on in our sessions. I asked her if he had had any changes in his life lately with work, sleep, diet, medication. She came to the session the next week and mentioned he started taking Gabapentin for sleep, as it was prescribed by his doctor when he went in for his yearly check up. She and I discussed how she could talk with him about if he felt the Gabapentin was helping his sleep or if he felt any side effects. The week after that, she reported that she talked with her husband and he told her that he noticed he felt more tired and groggy the next day after taking the Gaba. She said that his feeling tired caused a downward spiral that he realized made him feel depressed and then irritable so he decided the negative effects from the Gabapentin were outweighing the positives. 

I don’t share any of these stories to suggest that Gabapentin is an evil medication. There are many cases where Gabapentin has been helpful with few negative side effects. Nor do I want to suggest that if someone stops taking Gabapentin, then poof- miraculously they are better. Just like if someone takes a medication, poof they are cured. But being an informed patient is key and trusting when you don't feel like yourself even when your doctor tells you it isn't the medication when you suspect it might be is incredibly important to taking care of yourself and making your own informed choices.

Maybe that choice is to stay on Gabapentin because it is the best choice of medication considering all of the options. Maybe it is the option with the least negative side effects.

But when we know and are informed that a medication may cause a symptom, we can manage the symptom better because we know that symptom isn’t our fault or just in our heads.

I see this constantly in my practice. When people know that there is something actually physiologically going on that is out of their control, they manage that symptom better proactively because they can anticipate it and they are much kinder to themselves.

The withdrawals from Gabapentin.

The data points I have from my clients is that withdrawal symptoms from going off Gabapentin can be positively miserable. Clients hear from doctors they might feel "flu-like" symptoms such as "a little achey" or "uncomfortable" but again, what my clients have felt were similar to what they have some have experienced being on Gabapentin: they have felt outside of themselves, out of their minds, irritable, anxious, intolerant of any small disruption. I had 2 clients who experienced such horrible withdrawals from Gabapentin without knowing what was happening to them that they lost relationships with their partners because their partners said "I can't be with you anymore when you are like this" and left them. I have had a client who worried she was going to lose her job because she couldn't perform and needed to take a leave of absence when she was coming off Gabapentin.

I have had to create many plans with clients for how they will get the support they need from family and friends while coming off Gabapentin such as having back-up plans in case they need help picking up kids from school, making dinner, calling them on days they may feel low, getting them out of the house for walks or going for coffee if they are feeling depressed...

The bottom line is to be aware that Gabapentin is not the benign, harmless medication that it can often be made out to be. So be sure to talk to your doctor, get a second opinion, read reliable sources such as the Mayo Clinic, Harvard, Stanford, the National Institute of Health's websites and most importantly, trust your body and when you feel you aren't yourself. Also, just because something is a popular medication doesn’t mean that it doesn't come with risks.