By Dr. Shahrnaz Mashkoor, DNP, PMHNP-BC
If you’ve been exploring treatment options for anxiety, depression, or nerve pain, you’ve likely come across gabapentin—also known by brand names like Neurontin, Horizant, or Gralise. While it’s primarily prescribed as an anticonvulsant and for nerve pain, many people wonder: Does gabapentin help with depression or anxiety?
The short answer is that gabapentin isn’t FDA-approved as an antidepressant, but it is sometimes prescribed off-label to support mental health. Some patients benefit from it for mood instability, anxiety, or sleep issues, while others may not see much effect. Like any medication, its role depends on your unique needs and treatment plan.
In this guide, we’ll break down what gabapentin is, how it works, what research says about its use in mental health, and what to keep in mind if you or a loved one is considering it. The goal is to give you a clear, practical understanding—so you can have an informed conversation with your healthcare provider.
What Exactly Is Gabapentin?
Originally developed in the 1990s to treat seizures, gabapentin has found its way into mental health treatment rooms across the country. The medication works by calming overactive neurons in your brain – think of it as turning down the volume on an overly loud radio. This unique mechanism makes it useful for several conditions beyond epilepsy. Different formulations exist:
- Immediate-release gabapentin (taken multiple times daily)
- Gabapentin enacarbil (Horizant) — extended release, often used for restless legs syndrome (RLS)
- Gralise — another extended-release formulation for nerve pain
Gabapentin works by binding to voltage-gated calcium channels in the brain (the alpha2-delta site), which calms hyperexcitable neurons. That calming effect is why clinicians started trying gabapentin in a variety of conditions beyond seizures.
Approved uses vs. mental-health uses
Approved uses: epilepsy (partial-onset seizures), postherpetic neuralgia, and Horizant for RLS. Those are the indications with strong regulatory backing.
Off-label mental health uses: the medication is commonly used off-label for conditions that include:
- Adjunctive therapy for mood instability
- Anxiety disorders (some research suggests benefit for generalized anxiety)
- Adjunctive treatment in bipolar disorder
- Helping with insomnia, symptoms of withdrawal, and restless legs that can worsen mood and sleep
Is gabapentin an antidepressant?
Short answer: No. Gabapentin is not classified as an antidepressant. Antidepressants (SSRIs, SNRIs, bupropion, etc.) have a particular mechanism and FDA approval for major depressive disorder. Gabapentin is an anticonvulsant with mood-modulating properties. That said, many patients and clinicians report mood improvements when gabapentin is added to an existing regimen—especially when anxiety, insomnia, or neuropathic pain amplify depressive symptoms.
Does gabapentin help with depression? What does the evidence say?
The research is mixed. Some small trials and clinical reports suggest gabapentin can help treatment-resistant or partial-response depression when used as an adjunct to antidepressants or mood stabilizers. It appears most helpful when depressive symptoms are intertwined with:
- Severe anxiety or insomnia
- Neurogenic pain or neuropathy
- Mood swings, where calming neuronal excitability helps stabilize mood
However, gabapentin has not proven to be consistently effective as a primary antidepressant in large, high-quality randomized trials.
What about gabapentin for bipolar disorder?
Some clinicians use gabapentin for bipolar disorder as an adjunctive mood stabilizer, particularly when patients have anxiety or sleep disturbance alongside mood symptoms. The evidence is again mixed: gabapentin is not a first-line mood stabilizer like lithium, valproate, or certain antipsychotics. It may help selected patients—for example, those who can’t tolerate other stabilizers or who have comorbid neuropathic pain or alcohol-use problems. We weigh risks and benefits carefully when considering it for bipolar spectrum disorders.
Other gabapentin uses for mental health
- Anxiety: Some studies and clinical experience support gabapentin as an alternative to benzodiazepines for generalized anxiety—useful if someone has addiction risk.
- Insomnia: By calming the nervous system, gabapentin sometimes improves sleep quality, which indirectly helps mood.
- Alcohol withdrawal / craving: In certain settings gabapentin reduces withdrawal symptoms and cravings—helpful when treating co-occurring substance issues.
- Adjunct in PTSD or PTSD-related sleep problems: Limited evidence, but occasionally helpful.
These uses reflect real clinical practice. Gabapentin is often helpful as part of a package: sleep, therapy, nutrition, and sometimes medication.
Dosing, forms, and practical tips
Gabapentin dosing is highly individualized. Immediate-release forms are usually started low and titrated up (often multiple times per day). Extended-release options (Horizant, Gralise) have different dosing schedules—Horizant is commonly dosed once daily in the evening for RLS.
Important tips:
- Take as prescribed and space doses evenly.
- If you stop gabapentin, taper slowly—stopping abruptly can cause withdrawal symptoms (anxiety, insomnia, sweating, nausea).
- Adjust dosing for kidney impairment—gabapentin is excreted renally.
Side Effects: What You Should Know
No medication is perfect, and gabapentin has its share of potential side effects. The most common ones I see in my practice include:
- Drowsiness and dizziness (affecting about 20-30% of patients initially)
- Mild cognitive effects like difficulty concentrating
- Weight gain (typically 5-10 pounds over several months)
- Swelling in hands or feet
- Dry mouth
The good news is that most side effects are mild and often improve as your body adjusts to the medication. The drowsiness that bothers you in week one might actually become a benefit if you’ve been struggling with sleep.
However, there are some serious side effects to watch for. Call your healthcare provider immediately if you experience rash, difficulty breathing, swelling of your face or throat, or any thoughts of self-harm.
Important Safety Considerations
One thing I always discuss with patients is the importance of not stopping gabapentin suddenly. If you’ve been taking it for more than 6 weeks, stopping abruptly can cause withdrawal symptoms, including anxiety, insomnia, and even seizures in some cases.
Gabapentin uses for mental health often involve long-term treatment, so it’s crucial to work with your healthcare provider on any dosing changes. If you need to stop the medication, we’ll create a tapering schedule to gradually reduce your dose over at least a week.
Drug interactions are another important consideration. Gabapentin can interact with opioids, benzodiazepines, and even antacids. Always tell your healthcare provider about everything you’re taking, including over-the-counter medications and supplements.
Who Might Benefit from Gabapentin?
Based on my clinical experience, gabapentin tends to work particularly well for people who:
- Have depression with significant anxiety symptoms
- Experience treatment-resistant depression
- Deal with chronic pain alongside mental health issues
- Have bipolar disorder with prominent anxiety or sleep problems
- Need an alternative to benzodiazepines for anxiety
It’s especially worth considering if you’ve tried traditional antidepressants but still have breakthrough symptoms, or if you’re looking for a medication that can address multiple issues simultaneously.
Questions to ask your clinician
If you’re considering gabapentin or already taking it, ask:
- Why do you recommend gabapentin for my specific symptoms?
- What dose and formulation will you start with, and how will you titrate?
- How will we monitor for mood changes, sedation, or suicidal thoughts?
- What interactions or lifestyle changes should I be aware of?
- If it helps, how long will I likely continue it—and how will we stop it safely?
Explore Gabapentin Treatment with The Wellness Institute of Southern Nevada
So, is gabapentin an antidepressant? No. But can it help with depression, anxiety, or bipolar disorder? Sometimes—especially when used as an add-on treatment for symptoms like anxiety, sleep issues, or nerve pain. While it isn’t a first-choice mood stabilizer, gabapentin may play a supportive role in improving mental health when combined with the right care plan.
At The Wellness Institute of Southern Nevada, we use gabapentin thoughtfully—always alongside psychotherapy, lifestyle strategies, and careful monitoring. Every treatment plan is tailored to your needs because medication alone is rarely enough. The best results come from a balanced approach that also addresses sleep, nutrition, stress, and therapy.If you’d like to see whether gabapentin could fit into your treatment plan, schedule a free 15-minute consultation with us today. Together, we’ll review your history, current medications, and goals to create a safe, personalized plan that works for you.