Gabapentin for Mood Disorders: Evidence and Recommendations

Introduction to Gabapentin Use

The American Academy of Child and Adolescent Psychiatry guidelines for bipolar disorder do not include gabapentin among recommended first-line or maintenance treatments, which consist of lithium, valproate, and atypical antipsychotics (aripiprazole, olanzapine, risperidone, quetiapine, ziprasidone) 1
The American College of Physicians guidelines for major depressive disorder recommend cognitive behavioral therapy or second-generation antidepressants as first-line treatments, with no mention of gabapentin as a treatment option 2, 3, 4

First-line treatments for bipolar disorder include lithium, valproate, or atypical antipsychotics for acute mania/mixed episodes 1
Maintenance treatments for bipolar disorder include lithium or valproate, with lithium showing superior long-term efficacy 1
Treatments for bipolar depression include olanzapine-fluoxetine combination or mood stabilizer with carefully added antidepressant 1
First-line treatments for major depressive disorder include cognitive behavioral therapy or second-generation antidepressants (SSRIs/SNRIs such as sertraline, escitalopram, or venlafaxine) 2, 3, 4
Second-line treatments for major depressive disorder include switching to another SGA or augmenting with bupropion or buspirone 2, 4

Gabapentin carries risks of dependence and withdrawal symptoms, particularly when used long-term 5
Approximately 50% of patients prescribed gabapentinoids were treated continuously for at least 12 months, and sudden cessation can lead to physical and psychological withdrawal symptoms 5