Pregabalin for anxiety - warning

[Hipha]

Hello

I want anybody considering using pregabalin for anxiety to be aware of my experience. I was prescribed pregabalin 6 months ago for anxiety whilst on mirtazapine. I started low and over 2-3 weeks built up to 400 mg per days spread over 2 equal doses. I did not feel any benefit for my anxious symptoms especially nausea. At this point I had the opportunity to cease taking pregabalin as I have read many times that if no benefit is found within a few days after taking 150-200 per day then it is very unlikely that this drug will work for you. I reduced down to 300 without any side effects but then forgot to take a dose one day and experienced the worst withdrawal symptoms. I realised that withdrawal was not going to be easy and due to a family holiday I remained on 300 so as to not spoil the holiday. I then decided to withdraw from mirtazapine which took a further 2-3 months staying on pregabalin 300 all the while as withdrawing from both would be impossible. So here I am 6 months later trying to withdraw from pregabalin which is horrendous with flu like symptoms and nausea and anxiety. Tapering down 25mg at each drop and down to 100mg per day. I expect that it will require 3-4 months to withdraw completely.

I am not criticising pregabalin as I know it helps many people with anxiety. My message is if it does not give any benefit at 200-300mg then do not persist with it and stop using it as quickly as possible avoiding taking beyond 4 weeks. Everyone is different but there are many many stories on the web of horrific withdrawal experiences so please be aware.

[ricardo]

In my experience it is a drug initially produced for epilepsy and also for nerve pain.It is used for anxiety and you were on a pretty high dose,but generally speaking it is not an automatic first choice with many doctors purely for anxiety.

[keggsy]

To be fair Hipha, there are many many stories online of horrific withdrawal symptoms for all manner of AD's/anxiety meds.

For every one of those reports, there would I believe be significantly more unreported instances of people coming off such meds who experience little or only relatively minor withdrawal symptoms, if they are withdrawing properly.

Not belittling your experiences, just trying to add some counter balance.

[Hipha]

Thanks for your replies.

The difference keggsy is that pregabalin is not an AD and so staying on and persevering with it is not the same situation as with most AD drugs where effects can take many weeks or months to kick in. The point I am trying to get across is that if pregabalin is not giving benefit within several days at a dose of 200 or more then do no persevere with it and get off it quick saving the potential for a bad withdrawal later. I have not read any posts where somebody with anxiety gained benefit after waiting many months for it to kick in.

[hanshan]

I would agree that a quick response at a low dose is a very encouraging sign that pregabalin will be helpful. However, there have been people posting to NMP who have not felt much at the beginning, had to persist for a while and had to get the dose up to 300 - 400 mg per day before they felt any benefit after a few weeks.

As for withdrawal, again, some people can stop quickly and easily, and others need much more time and a careful taper. This is true of all psychoactive medications. Whenever I read a withdrawal "horror story" for a psychoactive medication, it's often because the person decides to stop cold turkey or similar.

[Hipha]

That is the challenge when trying pregabalin and any AD medication ; knowing when to accept that this drug that you had pinned your hopes on is not working and to let it go. The guidance for each drug provides a time range where benefit should be gained but this is guesswork and when considered alongside the many blogs and personal stories, leaves the patient with the tantalising chance that this drug might just work eventually. There is no way around this for AD drugs you just got to go with the flow and give it as much time as possible. With pregabalin however, relief for anxiety should be gained within a very short period of time. I am one of the unlucky people and am having awful withdrawal from pregabalin even though I have tapered down. Maybe I need to slow the taper.

[hanshan]

Hi Hipha,

Take the taper as slowly as you need - if you are feeling okay at a certain level and you want to go down a step, you can halve the taper or make it two thirds or three quarters by only reducing one day in two, three or four.

It's true that some people feel immediate benefit from pregabalin, but others take more time. This can be due to individual differences, or the fact that doctors are prescribing pregabalin for a wider range of problems. Also, prior medications will have changed the brain's chemistry, and that needs to settle.

Pharmacologically speaking, the drugs which affect neurotransmitter receptors directly have the quickest action - this includes benzodiazepines, opioids and drugs like cocaine. But when medications affect the neurotransmitters before they reach the receptors, it gets a little more complicated. Scientists like to say they know how it all works, but I suspect there is a lot they still don't know.

As for pregabalin, it delays the release of excitatory neurotransmitters, but how long that takes to have a response can only be determined from clinical practice.