Is it really so helpful and fairly harmless?
Chances are you or someone you know has been prescribed Gabapentin - aka Gaba or Neurontin. If you ask around, it might take 1 or 2 people to find someone who has been prescribed Gaba within the last year.
As a licensed Marriage and Family Therapist, I see individuals in my practice who range from age 10-70 and it is astonishing how many have been prescribed Gabapentin. What might be even more surprising are the explanations for why they’re taking it.
My understanding, when I first heard of Gaba years ago and was prescribed it for myself was that it targeted nerve pain. What I have since come to learn is that my clients are taking it for relatively simple issues such as improving sleep or decreasing general aches and pains.
Others are using it to treat more complicated conditions such as seizures, sciatica, restless legs, and fibromyalgia. 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 have also observed clients prescribed Gaba for mood regulation and anxiety. It was given to a client post-surgery as a positive alternative to stronger more addicting pain medications. A client was recommended Gaba when he went in for a sinus infection.
And it’s not just humans who take Gaba. One of my clients reported his cat was given a prescription to relieve its stress during the aftermath of the Montecito floods while another client’s dog took Gaba to treat incontinence and muscle weakness.
This is just the tip of the iceberg and I could go on and on… and on. Truly. But you are probably getting my point: Gabapentin seems to be generously prescribed.
On top of that, nearly all of my clients share some version of the story that their physicians say Gabapentin is a medication that has “been around for a long time and there are few negative side effects other than drowsiness and grogginess.”
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.
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. I respect the importance of being trained for the position you hold. It is 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 clear: I know Gabapentin has been lifechanging and instrumentally helpful for some people so I am not discouraging its use in any way.
However, I also want to report to you on the data my clients present to me of their lived experiences. And what that lived experience has been is far different from “grogginess or drowsiness”.
About a month 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 in the last several weeks and was worried she was sabotaging this new relationship. She said she had always struggled with self-doubt and low self-worth but she was really happy in life with her job and this new relationship but she really felt off and she didn’t know why. She felt irritable at times and felt she was reacting in ways she felt were out of character for herself and it was only after the fact that she would look back on the situation and feel ashamed and in disbelief at how she had acted. I asked her if she was on any medications and she said she had been on the same dosage of an antidepressant for a long time. I asked her if she had recently stopped taking any medication and she said Gabapentin.
I didn’t ask her the second question randomly. When I heard her describing that she didn’t feel like herself; she was surprised at how she was acting and was only able to recognize her behavior after the fact, the overlap with other clients who had either been taking Gabapentin or coming off Gabapentin and expressed the same feeling was a familiar story- worded so similiarly to other clients. Upon talking with them further, another shared experience was that none of them felt their doctors had informed them that anything like this could be a possibility from the Gabapentin nor did they feel their doctors really acknowledged their emotional experiences so they were left grappling with the feeling that something was wrong with them.
Another recent case is a client in his 60s who I have seen for several months but recently had shingles and was prescribed Gaba. He reported to me for two sessions that he felt he was losing her mind. He felt he was forgetting everything and started panicking that he was starting to get dementia. I suggested he talk to his doctor about the possibility of these symptoms being a side effect from the Gaba since he had not shown any symptoms of early onset dementia until that point. He came back the third week and reported that his doctor said he doubted the Gaba was causing these symptoms, but he told him he wanted to stop the Gaba anyways. It has now been six weeks and he reports he feels like himself again and his recall feels back to normal.
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 Gaba 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 the next day after taking the Gaba and strangely, feeling tired caused a downward spiral for him that made him feel depressed which then made him feel grouchy so he decided it wasn’t worth taking the Gaba since all-in-all, the total effects were negative so he stopped.
To reiterate: 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 little 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. I also never want to give the impression that I am the savior in these stories – the steps are awareness first, questions to the doctor, information from the doctor, a plan with the doctor, and informed decision making. Maybe the choice is to stay on Gabapentin. Maybe Gabapentin is the best choice of medication considering all of the options. Maybe it is the option with the least negative side effects.
Often when we know and are informed that a medication may cause a symptom, we can manage the symptom better because we know it isn’t our fault- there is something actually physiologically going on that is out of our control so strangely, we manage that thing better proactively because we can anticipate it and we are kinder to ourselves and we can let our partner know…
It is always wise to get more information from a wide range of sources… There are evidence based treatment methods but there is also, a lot of grey areas in mental health.
need to be especially careful not to claim to “have the answers” I am not so please talk to your doctor, get a second opinion, read from reliable sources such as the Mayo Clinic, Harvard, Stanford, the National Institute of Health etc.. Also, just because something is a popular medication or treatment doesn’t mean that it doesn’t hold value.
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