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. 1, 2, 3, 4, 5
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. 6, 7, 8, 9, 28
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.
Some of the symptoms of gabapentin withdrawal 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. 10, 11, 12, 13, 14, 15, 16, 17
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.
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.
Another factor that can contribute to the withdrawal timeline is kidney function. In a healthy adult with normal kidney function, the half-life of gabapentin is between 5 to 7 hours. In those with severely compromised kidney function, the half-life of gabapentin has been documented at about 52 hours. This is a substantial difference, and a longer half-life means that the body will clear the drug from circulation slower, thus the withdrawal timeline will be extended. This also means that, usually, as the timeline increases, the symptoms of withdrawal will not be as severe.
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. The first ones to emerge are usually increased anxiety, sweating, and headache. 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. These may then be joined by hyperactive cardiovascular function, tremors, increased sensitivity to light, stomach pain, and diarrhea. Insomnia will make sleep difficult over the next few days, and around three days after the last use the risks of delirium, seizures, and ataxic symptoms will be highest. Cravings for gabapentin, depression, and fatigue should be present by this time as well, and all of these symptoms may persist at their maximum intensity for several more days. 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. After days of little sleep or food combined with the acute symptoms of gabapentin withdrawal, someone is often exhausted. That being said, the beginning of 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.
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 often finds someone feeling a little better than the beginning of the third week. That being said, there is often still a great deal of room for improvement. 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 physical effects of gabapentin detox are not always dangerous, but in certain cases, they may pose increased risks. While they are often uncomfortable, depending on gabapentin use habits or co-occurring physical health issues, someone may be at a greatly increased risk of negative and potentially fatal outcomes.
A look at these physical effects on a system-by-system basis includes:
GABA plays a role all over the body, and this role is especially important in the brain where it acts to slow and moderate neurological impulses. Depending on the specific neurological system affected, GABA dysregulation can have a variety of wide-ranging impacts and effects during gabapentin withdrawal.
The risk of seizure is potentially the most dangerous effect of gabapentin withdrawal. Seizures in general can produce indirect risks through injuries sustained secondary to the seizure, such as having a seizure while driving, falling down, or biting through the tongue and asphyxiating. There are, however, other risks posed by seizures during gabapentin withdrawal in the form of an increased risk of status epilepticus. This is an extremely dangerous seizure state that is considered a medical emergency by healthcare professionals. If someone experiences a status epileptics seizure, they are at a greatly increased risk of brain damage or death due to this potentially fatal type of seizure. 15
Aside from seizures, another physical effect of gabapentin withdrawal is impaired motor function. This can come in the form of tremors, altered reflexes, or ataxia, a movement disorder that is characterized by awkward and uncoordinated movements. The most common form of ataxia experienced during gabapentin withdrawal is ataxic gait, and although this is rare and temporary, it is still noteworthy. 18, 19
The psychological effects of gabapentin detox can be quite disruptive to someone’s recovery. More than that, severe depression can lead someone to suicidal ideation and possibly suicide attempts. These are extremely serious effects and must be addressed to prevent potentially fatal outcomes. Additionally, these effects can be quite long-lasting, sometimes lasting for months or even years after acute withdrawal has resolved.
Some of the more common effects of gabapentin detox include:
These are two of the most common psychological effects of gabapentin detox, and they can sometimes be severe. While distinct effects, they have somewhat similar causes that can be both psychological and neurological.
From a neurological standpoint, neurotransmitter downregulation and neurological remodeling are most likely to blame for these effects, as the normal balance of mood-regulating and elevating neurotransmitters is disrupted. Due to the up- or downregulation that occurs to various neurotransmitter systems through gabapentin use, when someone stops using the drug, the brain is incapable of normal function without the drug. Furthermore, due to neurological remodeling and the changes the brain made during gabapentin use, negative emotional states are very common while the brain works to reverse these changes and return to pre-gabapentin levels of function.
Psychologically, the symptoms of depression and anxiety can be caused by the loss of such a powerful and unhealthy coping mechanism as gabapentin. Using this drug often starts out as a fun thing to do, but over time, it can become an emotional crutch and an increasingly necessary component of someone’s ability to handle stress. Even though they may know it is harmful, the calm and relaxation produced by gabapentin use can overpower the natural sources of stress relief and relaxation that someone may have used prior to gabapentin use. Once this crucial coping mechanism is suddenly removed, it is common for someone to feel helpless, hopeless, and alone. Depression and anxiety can take quite some time to resolve, but medications and therapy may be able to reduce the severity of symptoms and help someone develop new, healthier coping skills.
Cravings are another very common psychological effect of gabapentin withdrawal. While the neurological mechanisms for gabapentin cravings are not entirely clear, the behavioral causes are very similar to those of depression and anxiety. When losing a way to cope that can be as powerful as gabapentin, it is common for someone to reminisce about the comfort that using the drug produced. The intense physical and psychological discomfort produced by gabapentin withdrawal can increase this desire and craving, leading to obsessive thoughts about using gabapentin to achieve some sort of respite from the symptoms.
While it may not always be necessary to enter a gabapentin detox center, there are certain circumstances that may indicate entering one of these facilities is necessary. Depending on someone’s drug use habits, physical and mental health, or previous attempts to quit, these detox centers may provide the safest, most effective treatment options that can also give them the best possible chances to achieve successful, long-term recovery.
In these cases, it is highly recommended for someone to enter a gabapentin detox center:
Even though gabapentin does not act directly on the GABA neurotransmitter system, it can produce profound changes in this system through prolonged use. GABA is a major component and gatekeeper for seizure activity and downregulation of GABA receptors can lower the seizure threshold. This threshold sets the limit for how likely it is for a seizure to occur, and during gabapentin withdrawal, it is already lowered. If someone has a history of seizures or a seizure disorder such as epilepsy, they would be at a greatly increased risk to experience seizures during withdrawal. Due to the possibility of seizure-related injuries and the risk of the exceptionally dangerous seizure state of status epilepticus, it is very highly recommended that someone with a history of seizures enter a gabapentin detox center if they expect to undergo withdrawal.
Due to the prevalence of depression and anxiety during gabapentin withdrawal, if someone had suffered from a mental health condition that exhibited either, or both, of these symptoms, then they may experience more severe psychological symptoms of gabapentin withdrawal. Aside from depression and anxiety, other mental health issues can pose increased risks as well. If someone were to have co-occurring schizophrenia or bipolar disorder, for example, then they may suffer more severe withdrawal symptoms as well. These symptoms may also persist for longer than if they had no such mental health issues, as they may have already had a mood-regulating neurotransmitter imbalance prior to gabapentin withdrawal. This may also lead to an increased risk of suicidal ideation and suicide attempts. If someone had struggled with depression or anxiety before gabapentin withdrawal, it is highly recommended that they enter a gabapentin detox center.
If someone has tried to quit gabapentin on their own before and subsequently relapsed, then it may be beneficial for them to enter a gabapentin detox center if they would like to quit for good. Not only can these centers make the withdrawal and detox process less uncomfortable, but they can also provide therapies and treatments for any pre-existing or co-occurring trauma and mental health issues. Additionally, these centers can provide referrals to further treatment and care while also connecting someone with the local recovery community at large. All of these benefits can help someone build a solid foundation in recovery and can greatly increase their chances of long-term recovery.
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.
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