Gabapentin, known by brand names such as Neurontin, Gralise, and Horizant, is a medication primarily prescribed to manage nerve pain and certain seizure disorders. It is also used to treat restless legs syndrome. Although generally considered safe when taken as directed, increasing prescription rates have highlighted a growing concern regarding its misuse and potential for addiction in some individuals.
How Gabapentin Affects the Brain
Gabapentin works by influencing the activity of certain nerve cells in the brain. Its primary mechanism involves binding to the alpha-2-delta-1 subunit of voltage-gated calcium channels (VGCCs) in the nervous system. This interaction reduces the release of excitatory neurotransmitters, such as glutamate, which are involved in pain signaling and nerve excitability. By decreasing this excitatory activity, gabapentin can produce feelings of calmness and relaxation.
At higher doses, or when misused, these effects can intensify, leading to feelings of euphoria or a “high.” This can reinforce continued use, particularly for individuals seeking such effects. These changes in brain chemistry and the resulting sensations contribute to the drug’s addictive potential and can pave the way for dependence.
Factors Contributing to Gabapentin Addiction
Several factors increase the risk of gabapentin addiction. Individuals with a history of substance use disorder are at a higher risk. Co-occurring mental health conditions like anxiety or depression also contribute, as some individuals may misuse gabapentin to self-medicate these symptoms.
Combining gabapentin with other central nervous system depressants, such as opioids or benzodiazepines, significantly elevates the risk of misuse and dangerous side effects. Taking higher doses than prescribed, rapidly increasing the dosage, or obtaining the drug through illicit means are also common risk factors.
The Development of Dependence
Regular gabapentin use can lead to physical and psychological dependence. Tolerance can develop, requiring progressively higher doses to achieve the original effects. Physical dependence occurs when the body begins to rely on the medication to function normally, leading to withdrawal symptoms if use is stopped or significantly reduced.
Common withdrawal symptoms include anxiety, insomnia, sweating, nausea, and tremors. In more severe cases, seizures can occur, particularly if the drug is stopped abruptly, especially for those using it to control seizures. The discomfort of these withdrawal symptoms can compel individuals to continue using gabapentin.
Recognizing Misuse and Addiction
Recognizing gabapentin misuse or addiction is important. Observable behaviors may include taking more gabapentin than prescribed or using it more frequently. Individuals might also seek to obtain the drug illicitly, engage in “doctor shopping,” or fake symptoms.
Other indicators include using gabapentin to achieve a “high” or to enhance the effects of other substances. Neglecting responsibilities, continuing use despite negative consequences, and experiencing strong cravings for the drug are also significant signs. Experiencing withdrawal symptoms when attempting to stop or reduce use suggests dependence.