With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. This week, we focus the spotlight on Neurontin (gabapentin) – an anti-seizure/anticonvulsant medication that has mixed results in preventing mania and controlling anxiety. Following are some key facts about Neurontin:

• Neurontin is unrelated to other anti-seizure medications in terms of chemistry and how it works. It’s method of action is poorly understood.
• Neurontin has not been shown to be effective in treating acute mania or depression. In other words, if you’re currently experiencing mania or depression, Neurontin will not be effective in stopping the acute mood episode.
• While some older studies suggested that Neurontin might have a role in managing bipolar disorder, more recent and well designed studies have not supported these findings. At this time, it seems clear that Neurontin does not reduce mood cycling or the symptoms of depression or mania, although some consumers and prescribers have reported success in these areas, and it is still prescribed regularly.
• Neurontin may be effective in helping to control anxiety, but this has not yet been proven by any major studies. However, because it’s not addictive and is different from the SSRI’s, doctors will often try it in the treatment of anxiety especially in people with bipolar disorder.
• Neurontin has a very benign side-effect profile. (Weight gain is a rare side effect.) Also, Neurontin is generally well tolerated and has few of the other negative side effects often associated with anti-seizure medications.
• No reports show Neurontin interacting negatively with other medications used to treat or prevent bipolar symptoms, including MAOIs, lithium, Depakote, or Tegretol, so it’s generally safe to prescribe as an add-on medication.

One of the primary uses of Neurontin is to treat pain – specifically neuropathic pain (pain related to the nerves). It is also used, off label, in the treatment of migraines.

Although Neurontin’s side effects are typically few and mild, side effects most often reported include the following:

• Sleepiness (which can actually be a good thing if you have trouble sleeping)
• Edema – swelling of the extremities
• Fatigue
• Loss of appetite
• Muscle aches (although Neurontin is more likely to reduce pain than cause it)
• Dizziness
• Unsteadiness or tremors
• Nystagmus (rapid, involuntary fluctuation of the eyeballs)
• Blurred or double vision
• Mood and behavioral changes such as hyperactivity and irritability
• As with most of the anti-seizure medications, there have been some reports of new onset of suicidal ideation with Neurontin

One major disadvantage of Neurontin is that you need to take it up to four times a day, compared to twice a day for other anti-seizure medications.

There are no blood tests or blood levels to monitor when taking Neurontin. Doses can run quite high – up to 1200 mg per day – but higher doses means higher risk of side effects.

I do not use Neurontin much at all – I don’t prescribe it for mood episodes or managing bipolar disorder. I have some patients who have been on it for a long time, and they feel strongly that it helps to control their anxiety. It is generally very well tolerated, though, so I think it gets used a lot because it is thought of as low risk of harm, although I also think that for psychiatric purposes its potential benefits are low, as well.

Caution: Never stop taking any medication cold turkey, especially an anti-seizure medication. Withdrawing an anti-seizure medication too quickly can actually cause seizures. Always consult your doctor before you stop or decrease your medication.

If you’ve taken Neurontin for bipolar disorder or are a doctor who has prescribed it, please share your experiences, insights, and observations.

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From Psych Central's website:
Mood Stabilizers for Bipolar Disorder - Psych Central (January 14, 2009)

    Last reviewed: 24 Oct 2008