Gabapentin for Treatment-Resistant Depression

Introduction to Gabapentin

Gabapentin is primarily approved and recommended for neuropathic pain conditions, including diabetic neuropathy and postherpetic neuralgia, not for depression, as stated by the Mayo Clinic and the Journal of the American Geriatrics Society 1, 2

Clinical practice guidelines do not include gabapentin among recommended treatments for treatment-resistant depression, according to Depression and Anxiety, Molecular Psychiatry, and Annals of Internal Medicine 3, 4, 5
Controlled studies in adults have not found gabapentin to be helpful for bipolar disorder, which suggests limited mood-stabilizing properties, as reported by the Journal of the American Academy of Child and Adolescent Psychiatry 6

Treatment-resistant depression is typically defined as depression that has failed to respond to at least two adequate trials of antidepressants with different mechanisms of action, as defined by Molecular Psychiatry and Depression and Anxiety 4, 7
The American College of Physicians recommends switching to a different antidepressant class, such as from SSRI to SNRI or vice versa, as stated in Annals of Internal Medicine 5
Augmentation strategies with evidence-based options, such as second-generation antipsychotics, lithium, and thyroid hormone, are recommended by Molecular Psychiatry 4

The Journal of the American Geriatrics Society recommends starting with low doses of gabapentin (100-300 mg at bedtime) and titrating slowly, especially in older adults 2
Common side effects of gabapentin include dizziness, drowsiness, and unsteadiness, as reported by Mayo Clinic Proceedings, Annals of Oncology, and the Journal of the American Geriatrics Society 1, 8, 2
Dosage should be reduced in patients with renal impairment, as stated by the Journal of the American Geriatrics Society 2

Current evidence does not support gabapentin as a standard treatment for treatment-resistant depression, according to the Journal of the American Academy of Child and Adolescent Psychiatry, Depression and Anxiety, and Molecular Psychiatry 6, 3, 4
The American Psychiatric Association recommends prioritizing evidence-based approaches for treatment-resistant depression, including switching antidepressants, augmentation with approved agents, or referral for non-pharmacological treatments like ECT, as stated in Molecular Psychiatry, Annals of Internal Medicine, and Depression and Anxiety 4, 5, 7