Neurontin and Its Off-Label Use in Bipolar Disorder

Neurontin (gabapentin) is sometimes prescribed off-label to treat bipolar disorder.

Let's review the basics on Neurontin, including side effects and whether science supports its use as a mood stabilizer.

What Medical Conditions Is Neurontin Approved to Treat?

Neurontin is a medication approved by the FDA to treat partial seizures and postherpetic neuralgia, pain that remains after someone has shingles. 

Potential Serious Side Effects

According to the FDA, Neurontin may increase the risk of suicidal thoughts or behavior.

Patients treated with any anti-seizure medications, like Neurontin, should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior.

Neurontin may also cause a serious allergic reaction that can impact a person's liver or blood cells, but alone, it does not cause jaundice or elevated liver enzymes. In fact, it is known to be a liver-friendly drug.

Signs of an allergic reaction may include:

• Rash
• Trouble breathing
• Fever
• Swollen glands that don't get better
• Swelling of the face, lips, throat, or tongue 

Symptoms or signs of liver or blood cell problems may include:

• Yellowing of the skin or eyes
• Out of the ordinary bruising or bleeding
• Severe fatigue
• Out of the ordinary muscle pain
• Frequent infections

Neurontin can also make a person feel dizzy or sleepy. This can affect their driving abilities. According to the FDA and manufacturer, it's important to discuss with your doctor whether it's safe for you to drive while on Neurontin.

It's also advised to avoid alcohol and not take other medications with Neurontin until you speak with your doctor, as this can worsen your sleepiness. People with renal (kidney)

Potential Common Side Effects

Neurontin may cause serious side effects, including:

• Loss of balance or coordination
• Fatigue and/or drowsiness
• Infection with viruses
• Fever
• Jerky movements
• Nausea and vomiting
• Difficulty speaking
• Double vision
• Tremor
• Unusual eye movements

Controversy in Treating Bipolar Disorder

While a number of anti-seizure medications, like Tegretol (carbamazepine), valproate, and Lamictal (lamotrigine), are approved by the FDA for treating bipolar disorder, Neurontin (gabapentin) is not. 

In 1993, Neurontin was approved by the FDA for the treatment of partial complex seizures, in combination with another anti-seizure medication.

Does Science Support Neurontin's Use for Bipolar Disorder?

A 2009 review in General Hospital Psychiatry, regarding gabapentin as a mood stabilizer, found no reports of studies meeting high-quality criteria — and the results of those studies examined were mixed, favoring a negative role for gabapentin's use in treating bipolar disorder. 

That being said, according to a 2007 review study in the Annals of General Psychiatry, Neurontin can be used as a supplementary therapy for the treatment of anxiety in patients with bipolar disorder. 

What Should I Do?

It's always a good idea to be knowledgeable about your medications. That being said, do not stop taking a medication without first speaking with your doctor. Withdrawal symptoms can occur. While the science is not robust regarding gabapentin's effectiveness in treating bipolar disorder, it may just work for you—each person has to evaluate their own response with their doctor.