Q:  Anxiety-Panic Attacks-Neurontin

Hi Dr. Phelps,

I have Bipolar Disorder and I am having panic attacks and anxiety. I am on Depokote ER and Zyprexa. The doctor wants to add Neurontin. I know Neurontin hasn't been shown to help as a "stand alone" mood stablizer, but have you see Neurontin help people with BP that have anxiety and panic? Also.. is the anxiety a symptom of the BP? Thank You Jess

Dear Jess -- 
You'll have to try to discuss this with your doc'.  In my experience, Neurontin helps quite a bit as an antidepressant, and often as an antianxiety agent, especially at first.  Then, after months, things just don't settle down and stay stable.  When in those circumstances I've taken the Neurontin out, things seem to settle down (although it's pretty subtle and hard to know these things for sure).  You have to wonder, since Neurontin clearly helps people quite a bit, right at first, why the studies show it to be no better than placebo, maybe a little worse.  That has to mean there are people getting quite a bit worse with it, even in the short run (I've seen that quite often too), to end up the the Neurontin group as a whole coming out about even with placebo.  So, as you have gathered, I'm not much of a fan of Neurontin.  

Anxiety can indeed by a symptom of BP, in my opinion, although that's coming from my experience with patients more than from seeing it in print (I'm surprised by the lack of the latter and so trying to keep open the idea I'm wrong about this!).  So when I see it in my patients, I treat it as though  it marks continued "manic-side" symptoms (it almost always is accompanied by sleep problems, for example) and therefore try to add mood stabilizer effects, or certainly, if they are present, try to get rid of anything that can make bipolar disorder worse, like an antidepressant especially (or steroid, or irregular work schedule, or alcohol).  

Dr. Phelps

Published July, 2001