Pregabalin for Treatment-Resistant GAD?
Living with Generalized Anxiety Disorder (GAD) can be an uphill battle. Constantly wrestling with intrusive worries and fears can disrupt daily life and diminish one’s overall quality of life. While many individuals with GAD find relief through therapy, lifestyle changes, and medications like SSRIs, there are some who remain resistant to treatment. Close to 50% of the patients treated for GAD will not respond to first-line treatment.
Treatment-resistant GADÂ is usually considered when a patient does not respond to at least 1 antidepressant at an adequate dose for an adequate duration.
IS PREGABALIN FDA APPROVED FOR GAD?
- Pregabalin is NOT FDA approved for GAD.
It is currently FDA approved for
- Neuropathic pain associated with diabetic peripheral neuropathy
- Postherpetic neuralgia
- Adjunctive therapy for the treatment of partial onset seizures in patients 4 years of age and older
- Fibromyalgia
- Neuropathic pain associated with spinal cord injury
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BUT….
According to Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders: Pregabalin is recommended for GAD as:
- First Line: Alone
- Second Line: as Adjunct
HOW DOES PREGABALIN WORK?
- Pregabalin potently binds to the alpha2-delta subunit of the voltage-gated N-and P/Q-type calcium channels in CNS –> this decreases the presynaptic calcium currents –> which modulates the release of neurotransmitters, including glutamate, substance P, and calcitonin gene-related peptide from excited neurons. (Expert Rev Neurother. 2007;7(7):769–81)
PREGABALIN VERSUS BENZODIAZEPINES?
- Unlike Benzodiazepines, pregabalin does not exacerbate GABA-mediated responses nor does it affect GABA reuptake or GABA transaminase inhibition. (Ment Health Clin. 2020 Nov; 10(6): 326–334)
Psychiatry Education Forum Academy has discussed this clinically relevant topic discussing the AUGMENTATION and SWITCH options for Treatment-Resistant GAD.
Here is one slide from this presentation on the role of Pregabalin for this indication:
TREATMENT RESISTANT GAD:
AUGMENTATION & SWITCH OPTIONS
TREATMENT-RESISTANT GAD: (1) AUGMENTATION OPTIONS
- Discuss Eight (8) augmentation treatment options.
- Total: 30 min video discussion.
- Classify them based on recent literature and recommendation level based on guidelines.
TREATMENT-RESISTANT GAD: (2) SWITCH OPTIONS
- Discuss Twelve (12) augmentation treatment options.
- Total: 30 min video discussion.
- Classify them based on recent literature and recommendation level based on guidelines.
At the end of this discussion: you will have answers to the following sections:
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