Pregabalin (Lyrica) for Anxiety

Because I’m plagued by anxiety, I’m always interested in any unorthodox methods of dealing with it. While “benzos” would work for the immediate problem, I can’t (and am not allowed to with my opioids) take them all the times I’m anxious.

With all my researching, I’m surprised to discover that I missed a solution that seems obvious in retrospect: the Lyrica I’m prescribed, which I take on an “as needed” basis for a certain kind of pain, can also act as an anti-anxiety medication.

Here are a couple of PubMed abstracts showing that Lyrica (pregabalin) has been evaluated for anxiety for years already:

Pharmacokinetic evaluation of pregabalin for the treatment of generalized anxiety disorder. – PubMed – NCBI – Mar 2017

Pregabalin is an alternative compound to SSRIs and SNRIs for the first-line treatment of generalized anxiety disorder (GAD).

Areas covered:

We describe the pharmacokinetic properties of pregabalin and their implications for the treatment of GAD.

A search in the main database sources (Medline, ISI, Web of Knowledge and Medscape) was performed in order to obtain a comprehensive and balanced evaluation about the clinical implications of the pharmacokinetic properties of pregabalin in the treatment of GAD. The word “pregabalin” was associated with “pharmacokinetics”, “interactions”‘, “GAD”, “anxiety” and “tolerability”. No restriction criteria were established in relation to methodology or publication year. Only English-language articles were selected.

On the other hand, prescription of pregabalin should be handled with caution to minimize the incidence of renal impairment (especially in elderly patients), where a history of substance misuse or concomitant medications (e.g. anti-hypertensives or some antibiotics) are risk factors that can affect renal function.

Expert opinion:

Pregabalin is a safe and efficacious compound for GAD treatment.

Short half-life (preventing persistence of side effects), absence of active metabolites and no interactions with CYP450 enzymatic system are all favorable pharmacokinetic properties for the treatment of GAD patients, including those with comorbid depressive symptoms or medical conditions.

That last sentence makes it sound like this would be the perfect answer for me because I definitely have comorbid “depressive symptoms” (why do they call it a symptom, not a disease?) and a medical condition, EDS.


And this study from 4 years ago evaluated Lyrica versus Zolot (SSRI):

Pregabalin versus sertraline in generalized anxiety disorder. An open label study. – PubMed – NCBI2015

OBJECTIVE:
Generalized Anxiety Disorder (GAD) is a chronic mental illness with a prevalence of 5-7% in the general population. 

GAD is characterized by extreme persistent worry, mostly about minor problems, involving pathological fear with high occurrences of vegetative disturbance.

For me, my anxiety feels more like dread: I dread every next moment when something terrible is sure to happen, something I will have caused or not prevented, something that I will have to fix even though I won’t be able to.

According to the guidelines of the World Federation of Societies of Biological Psychiatry (WFSBP), the first-line treatments for GAD are

  • Serotonin selective reuptake inhibitors (SSRIs),
  • Selective serotonin- and norepinephrine reuptake inhibitors (SNRIs) and
  • pregabalin, an atypical anxiolytic.

In this study, both efficacy and tolerability of pregabalin were evaluated and compared with efficacy and tolerability of sertraline, an SSRI antidepressant.

PATIENTS AND METHODS:

107 patients both male and female, aged 20-60 were included in the study. Patients fulfilled criteria for GAD, according to ICD-X and DSM-IV.

Each patient was randomly assigned to 4 weeks of treatment with pregabalin (n=47) or sertraline (n=60).

RESULTS:

Both pregabalin and sertraline showed good results in treating symptoms of Generalized Anxious Disorder.

The onset of action was shorter in treatment with pregabalin compared to the treatment with sertraline.

In the patients treated with sertraline, the anxiolytic effect was detectable after at least 14 days while pregabalin showed initial good results during the first week of treatment.

Adverse effects were reported in 28% patients treated with pregabalin and 27% of patients treated with sertraline, without significant differences.

There were no drop-out patients in neither group. Beside pharmacotherapy, each patient received 8 weeks of cognitive/behavior therapy. In concomitant therapy benzodiazepine was used (klonazepam, in low doses).

In all patients adverse events were short-lasting withmild intensity and there were no withdrawal events during this study.

CONCLUSIONS:

Efficacy and tolerability of pregabalin were high.

Compared to sertraline, pregabalin showed more rapid onset of action and equal efficacy. Adverse reactions are short-lasting and the dose depends.

Our investigation showed that pregabalin, an atypic anxiolytic is efficient and well tolerable in treatment of GAD.

Read full text in European Review for Medical and Pharmacological Sciences

6 thoughts on “Pregabalin (Lyrica) for Anxiety

    1. Zyp Czyk Post author

      I’m sorry, but that book seems wrong – it says right on the cover, “No Need to Suffer” and we know that’s certainly not true anymore.

      It used to be that doctors prided themselves on relieving human suffering, but these days we treat dogs better. If we did to pets what we’re doing to people, leaving them to suffer without pain relief, it would be recognized as abuse.

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      Reply
      1. louisva

        I’m sorry, Didn’t intend to push a button. “No Need to Suffer” refers only to panic attacks. He has a biological point of view on depression and anxiety and his medications have helped me a lot. I very seldom have panic attacks anymore.

        Liked by 1 person

        Reply
        1. Zyp Czyk Post author

          Sorry, I wasn’t entirely serious when I said “it seems wrong”. It’s just that I so desperately wish it were still true.

          I totally agree that with the right meds, like opioids and benzos, suffering is dramatically decreased. But that’s clearly not a priority for the medical establishment these days. Even if a doctor knows you need this “dangerous” combination, their hands are tied by various “guidelines”. I feel for the good doctors that are no longer allowed to relieve the suffering of their patients according to their own professional experience and judgement. That’s what real doctoring is.

          I have spells/days of generalized anxiety that’s paralyzing when it hits. I’m almost feeling panic at the thought of having to live through these times and I’ve suffered from depression since I was 15 – I guess that qualifies as treatment-resistant :-)

          When in my anxious state, I’d be willing to try just about anything, including electroshock therapy, to free myself from that misery. For a while (several years ago), I was prescribed Xanax and it was a blessed relief, but with the new “guidelines” they are no longer allowed to prescribe it, so I’m left suffering.

          Guidelines have replaced doctors’ decisions and that is NOT proper medical care!

          Liked by 1 person

          Reply
          1. louisva

            Thanks for the reply. I was concerned that I said the wrong thing and made you angry. The doc that wrote the book, my shrink, has been treating me longer than I’ve been taking pain meds and does not play a role in my pain care. In the early editions of this book did not have the “no need to suffer” comment leading me to think it’s a marketing thing. Fortunately no one has tried to mess with my benzos.

            Liked by 1 person

            Reply
            1. Zyp Czyk Post author

              You’re so considerate and kind, I can’t imagine anyone getting angry with you – certainly not me! I’m so glad we straightened that out. I also had an excellent therapist for many years and he helped me tremendously, but he wasn’t able to change my brain chemistry so I’ll probably have to take antidepressants forever.

              My anxiety seems biological as well because no amount of “right thinking” can ease it. It’s a weird feeling, observing myself being anxious, knowing nothing has changed in my life, and still being terrified. I watch myself becoming irrationally afraid and dreading every next moment, even when I know there’s nothing to be afraid of. Logic has little power against this kind of pathological anxiety, argh!

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