Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN
Written By: Phillippe Greenough
Article Updated: 01/25/2021
Number of References: 27 Sources
Gabapentin is a common anticonvulsant and neuropathic pain medication that is increasingly been a cause for concern regarding abuse and addiction in recent years. Long thought to be incapable of abuse, large amounts of gabapentin can produce euphoria and consistent use can produce physical dependence. Once dependence develops and someone suddenly stops taking the drug, the symptoms of gabapentin withdrawal may last for a week or two and can include stomach pain, tremor, and delirium. In this article, we will examine the way this drug works, the symptoms of gabapentin withdrawal, the timeline involved, and when a gabapentin detox center may be recommended.
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The symptoms of gabapentin withdrawal can vary, sometimes substantially, between individuals. This is due to multiple factors, most importantly someone’s specific gabapentin use habits, but genetics, history of seizures, kidney function, poly-drug addiction, and co-occurring mental health issues may also affect the severity and duration of withdrawal symptoms. These symptoms can range from a little uncomfortable, to potentially life-threatening depending on how much or how long someone used gabapentin.
Currently, there has not yet been a study of the gabapentin withdrawal timeline in large numbers of people. Due to this, the exact timeline cannot be known at this point. For a broad generalization of the gabapentin withdrawal timeline in a healthy adult, we will take a week-by-week look at the course of the first month of gabapentin withdrawal:
Within 12 hours of the last drug use, the symptoms of gabapentin withdrawal will begin to appear. These symptoms may be very minor for the first day or so but may begin to escalate on the second day after the last use. By the end of the first week, the physical symptoms of gabapentin withdrawal may begin a slow resolution. The beginning of the second week will often start out quite rough. That being said, the second week often shows some improvement in the intensity of symptoms. The risk of delirium, seizures, and ataxia will reduce and is often followed by reductions in cardiovascular hyperactivity, nausea, and tremors. Diarrhea may persist throughout the week but often improves as the days pass. Photosensitivity and headaches will often resolve during this time as well, and by the end of the second week, the physical symptoms have often resolved entirely.
Some of the symptoms that could be expected during the first 2 weeks of gabapentin withdrawal may include:
These symptoms are rarely fatal in and of themselves but in the presence of pre-existing physical or mental health issues, there may be an increased risk of potentially dangerous outcomes. An especially noteworthy risk is that of seizures and the possibility of an extremely dangerous seizure state known as status epilepticus. Seizures in general, and status epilepticus in particular, can increase the chances of brain damage, death, or injuries sustained secondary to the seizure itself.
While the physical symptoms may have resolved, the psychological symptoms are usually still present. As the physical symptoms resolve, it is common for the psychological symptoms to seem more intense. This has to do with the fact that since the distractions provided by the physical symptoms are no longer present, someone will be more aware of their psychological discomfort. These mental symptoms may reduce somewhat throughout the week, but this reduction is usually quite minor. The fourth week shows further, steady improvement in symptoms. That being said, there is often still a great deal of room for improvement.
Some of the symptoms that may be expected during the third and fourth week of gabapentin withdrawal could include:
While psychological symptoms may still persist for further weeks, months, or sometimes even years, there are treatment options available to help reduce the severity of these symptoms. Both medications and clinical therapy can help reduce these psychological symptoms and give someone some relief while their brain works to undo the changes made during gabapentin addiction. Medications may be able to treat the symptoms, but the only way to permanently heal the causes is through continued abstinence from gabapentin.
The timeline for gabapentin withdrawal can exhibit substantial differences between individuals, and many factors can affect this timeline. Similar to the intensity of withdrawal symptoms, the largest contributing factors have to do with someone’s gabapentin use habits, including the amounts used and duration of use. These factors can affect the timeline of both phases of withdrawal, however, they have a much greater impact on the post-acute withdrawal timeline. The more of the drug someone used and the longer they used it, the longer the post-acute withdrawal symptoms can linger.
The post-acute symptoms of withdrawal are often much longer-lasting although usually less severe than the immediate phase of withdrawal. These symptoms are strictly psychological in nature, but they may still pose risks and challenges to someone trying to recover from gaba[pentin addiction.
Some of the post-acute symptoms of gabapentin withdrawal include:
These symptoms may appear minor at first glance, but these may still present potentially dangerous risks. Depression and anxiety can lead to suicidal ideation and, unfortunately, suicide attempts. Needless to say, this can result in fatal outcomes and is tragic for all parties involved. Even though the worst of the gabapentin withdrawal symptoms may be resolved after a few weeks, effective treatment and support are required if someone is to have the best possible chance of achieving long-term recovery.
Gabapentin is most frequently prescribed for neuropathic pain conditions and sometimes, as was it’s original use, to treat certain seizure disorders. It is a structural analog of the neurotransmitter GABA, although it does not work directly on GABA receptors. A member of the gabapentinoid class of drugs, gabapentin’s primary mechanism of action is on the α2δ-1 and α2δ-2 subunits of voltage-gated calcium channels with a higher affinity for α2δ-1. While the exact mechanism is unclear, gabapentin is able to interface with these subunits which subsequently inhibits the release of excitatory neurotransmitters. This leads to an overall neurological depressive effect that can manifest psychologically and physically. While gabapentin does not directly act on the GABA neurotransmitter system, it has been shown that gabapentin use does increase the concentrations of GABA in certain brain regions. Gabapentin may also interact with the excitatory neurotransmitter glutamate through antagonist action at NMDA glutamate receptors, although this is currently unclear.
When taking gabapentin for long periods, or in large doses, the brain will begin to make changes to maintain balance. The specifics of gabapentin’s primary mechanism of action are still unclear, so the exact way that gabapentin produces withdrawal is up for debate. What follows are logical assumptions based on the neurotransmitter systems that gabapentin acts on, and how these systems behave with other drugs of abuse similar to gabapentin. Firstly, since the levels of certain excitatory neurotransmitters have been reduced, the brain will increase sensitivity to them through a process known as upregulation. Secondly, since GABA levels have increased, the brain will reduce sensitivity to GABA through a process known as downregulation. Finally, a further process of neurological remodeling will occur after these regulatory processes have begun. This is the process of the brain making structural changes to better operate in this dysregulated environment. Once these changes have been made and gabapentin use is ceased, someone will begin to experience the symptoms of gabapentin withdrawal.
Gabapentin addiction can be demoralizing, destructive, and at times, may seem like it is a life sentence. This is absolutely not true, and recovery is possible. It may be scary and it may be difficult sometimes, but with help, it can become a reality. All that is required to start the journey towards freedom from gabapentin addiction is the courage to ask for help, and the willingness to accept help. Don’t wait until tomorrow, recovery can begin today.
There are several other depressant drugs that can produce uncomfortable or even dangerous withdrawal symptoms. We have more in-depth withdrawal guides for drugs such as:
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