For many people, gabapentin is a simple antiseizure drug they take to help them with their epilepsy and neuropathic pain. For a number of other people, gabapentin becomes a psychological need that develops into an unexpected source of abuse. The long-term effects of gabapentin are an example of what happens when the line between prescription use and unhealthy use is crossed.
What Is Gabapentin Used For?
Gabapentin is sold under the brand name Neurontin, an anticonvulsant drug that is prescribed for the treatment of epileptic seizures and the management of nerve pain, such as the kind of pain that is associated with shingles. Gabapentin is a relatively recent drug, with its formulation being finalized as recently as 2004. Its molecular structure bears a resemblance to the GABA neurotransmitter, which the human brain normally produces to reduce electrical activity in the central nervous system. If a person has a brain that cannot produce sufficient levels of GABA, the results usually present in the form of anxiety or panic disorders, or epileptic seizures. Gabapentin, therefore, introduces GABA-like changes into the brain, diminishing abnormal activity, and giving the patient more mood regulation and protection from seizures.
For these reasons, gabapentin has been approved by the Food and Drug Administration for the treatment of epileptic seizures and neuropathic pain. However, gabapentin also has nonapproved uses. Its effect on the GABA neurotransmitter has led to doctors suggesting it to patients for the management of various other conditions, such as alcohol withdrawal, restless leg syndrome, certain symptoms of diabetes, and hot flashes, among others.
Gabapentin is a relatively simple drug, but its pleasant and relieving effects have raised concerns that it could be abused, either by patients who desperately want alleviation from their symptoms or by recreational users who mix the medication with other substances to enhance the desired effect. According to the British Journal of General Practice, the feeling of gabapentin tranquilization is comparable to the sense of peacefulness that comes from using cannabis. The increase of GABA neurotransmitters makes patients feel more relaxed and content than they have felt in potentially a long time, and for patients dealing with nerve pain, withdrawal symptoms or the fear of epileptic seizures, that comfort can be hard to shake off. For some, the compulsion to take more gabapentin than prescribed is too hard to resist.
Common Side Effects of Gabapentin
On its own, gabapentin has a lower risk for abuse than similar benzodiazepines and opioids; but like any drug, gabapentin causes side effects, the nature and severity of which depend on how much of the medication is consumed, and for how long. At the shorter end of the spectrum, the effects are mostly tolerable and will pass after the body becomes accustomed to the effects of the gabapentin. Mayo Clinic lists some of the milder and short-term effects of gabapentin:
- Loss of balance
- Some changes to mood and temperament
- Difficulty with visual focus, sometimes seeing double
The loss of balance and difficulty with movement coordination tend to present more in elderly individuals, who are at a high risk for falling injuries. Children tend to experience mood changes and periods of depression when taking gabapentin.
Not all patients will experience gabapentin side effects, and most will feel only the milder effects of gabapentin use when they go on a prescribed regimen. But taking higher doses of gabapentin, or taking it for very long periods of time, increases the severity of the side effects. According to WebMD, these can be anything from swelling in the hands and feet to extreme mood swings (ranging from mania to depression, with suicidal thoughts). Some patients experience short-term memory loss and mental disorientation while others note generalized pain, usually concentrated in the stomach.
Serious Side Effects of Gabapentin
In emergency cases, some people might struggle with breathing problems and kidney issues. These are likely among those who have had lung or kidney issues in the past, or who are using gabapentin with other substances (medicinal or otherwise). In very rare cases, individuals might suffer an allergic reaction that could be very dangerous. Swelling in the mouth, tongue or throat, or very intense itching, usually signals the onset of a critical allergic reaction that requires immediate medical attention.
Side effects of gabapentin carry the risk of developing adverse physical effects in both the short-term and long-term for patients. The American Journal of Medicine carried the results of a study that suggested that people who had a pre-existing kidney problem before taking gabapentin are at risk for developing gabapentin toxicity, which can be fatal. Gabapentin is broken down into its chemical constituents in the kidneys, and those who have kidney problems (the elderly, for example, or those who struggle with chronic kidney disease) are in danger of the gabapentin components staying in their systems for longer than necessary, leading to gabapentin toxicity. Gabapentin toxicity could also develop in people who take more gabapentin than they should, whether out of a misguided desire for relief or for recreational purposes.
Long-Term Side Effects of Gabapentin
A further effect of long-term gabapentin use arises when a person who has been taking the medication for a long period of time tries to abruptly discontinue use. This places a lot of stress on the brain because it has gotten used to relying on the augmented GABA neurotransmitter production for improved functioning in the central nervous system. Taking the gabapentin away without proper care can lead to the development of distressing and potentially dangerous withdrawal systems, as the brain and body struggle to adapt to the sudden lack of gabapentin. For those with epilepsy, this is of special concern; without gabapentin, they are at risk for experiencing seizures, which can be very hazardous if they happen with other withdrawal symptoms. Similarly, patients who were taking gabapentin to control their bipolar disorder could experience unpredictable and harmful mood swings, which can be dangerous if they happen during the withdrawal process.
The symptoms and severity of withdrawal symptoms depend on a number of different factors, some to do with the nature of the gabapentin consumption and some to do with the individual’s individual physiology. The longer the gabapentin consumption, the more difficult the withdrawal process usually is. It might last for a full week, if not longer, and the person’s symptoms will likely require the most time and care to endure. Due to this, people should not attempt to discontinue gabapentin without proper medical supervision. Not only will they risk a return of the conditions for which they had been prescribed gabapentin to begin with, but in the case of long-term gabapentin use, the effects can be so painful and distressing that there will be the temptation to go back to gabapentin, even if the intention behind discontinuation was to break the habit of using it. Withdrawal is a complex medical process of the brain trying to create new neurotransmitters after weeks and months of chemical suppression. Going back to gabapentin during such a vulnerable time will likely deepen the dependence on the drug and make the use of it even harder to break.
In order to mitigate the effects of trying to discontinue long-term use of gabapentin, patients should consult with a doctor on how best to taper off their use. This will likely entail remaining on gabapentin for a period of time while incorporating the use of other medications and therapies to treat the condition for which the gabapentin was prescribed.
Gabapentin Abuse and Addiction
If the gabapentin use continues unabated, there is the risk of the long-term use spiraling into abuse and addiction. Despite the low potential for abuse if used therapeutically, gabapentin is nonetheless a psychoactive medication, and it creates a euphoric high that has been compared to that of opioids and other substances such as cannabis. Using gabapentin for unapproved purposes, such as to counteract opioid withdrawal symptoms or to increase the effect of methadone, can lead to people becoming psychologically dependent on the medication, which can develop into abuse and addiction over time. Mixing gabapentin with opioids increases the risk for respiratory depression, which can slow down breathing to the point that vital organs like the brain and heart don’t get enough oxygen to function.
Long-term use of gabapentin has also been known to cause weight gain. Therapeutic use of gabapentin should not have this effect, but some research has shown that weight gain can occur when the medication is taken at high doses. Not much is yet known about why this happens, but the common side effects of drowsiness and fatigue may contribute to a lack of exercise and a slowing down of metabolism. Patients who have been taking gabapentin for a short-period of time might notice some mild fluctuations in their weight; this is usually due to their individual physiology adjusting to the chemical changes of the drug. The weight changes persist during the first few weeks of treatment, but will likely not persist beyond that time.
For those who have been on gabapentin for a while, however, the body becomes more prone to the range of side effects that come with use, including weight gain. Various physiological processes become affected after continual exposure to drugs, and the change in metabolic rate induced by gabapentin will likely result in unexpected weight gain for these patients.
Long-Term Therapeutic Use of Gabapentin
Even for therapeutic applications, like fibromyalgia, prolonged use of gabapentin has led to mixed results. A writer on Fibromyalgia News Today notes that being prescribed gabapentin led to facial twitching, dry mouth, and swelling. She concluded that the habit-forming nature of gabapentin, combined with long-term effects that range from embarrassing to concerning, outweighed the benefits of the medication treating her widespread muscle pain.
In 2002, The Clinical Journal of Pain reported on the results of a study that was conducted to determine whether gabapentin could be used as a long-term treatment for pain after a spinal cord injury. Researchers noted that 22 percent of the 27 patients in the study discontinued their participation in the trial due to “intolerable side effects.” While some patients did report a favorable response to the long-term program of gabapentin, the most common side effects for up to three years following the first dose were “sedation, dizziness, and forgetfulness.” As much as 91 percent of patients said that despite the presence of side effects, gabapentin proved useful as a multiyear painkiller for their spinal injuries.