The treatment of generalized anxiety disorder with pregabalin, an atypical anxiolytic

Jeffrey R Strawn^1,2,3, Thomas D Geracioti Jr^1,2,3

¹Department of Psychiatry, University of Cincinnati, College of Medicine, Cincinnati, OH, USA; ²Research and ³Psychiatry Services, Cincinnati Veterans Affairs Medical Center Cincinnati, OH, USA

Abstract: A constellation of pharmacologic treatments for generalized anxiety disorder (GAD) have been developed over the past five decades, although each has a number of potential drawbacks in clinical practice. This review addresses one potentially new pharmacologic treatment for generalized anxiety disorder, the gamma-aminobutyric acid analogue pregabalin. We review the mechanism of action, and pharmacokinetic and pharmacodynamic properties of pregabalin as well as the results of 5 double-blind, placebo-controlled trials of pregabalin in the treatment of generalized anxiety disorder (GAD). Based entirely on data from these industry-sponsored (Pfizer), multi-site clinical trials in patients with GAD, pregabalin appears to be generally well tolerated and has rapid onset of action (approximately 1 week), comparable efficacy to benzodiazepines and lower discontinuation rates compared with other pharmacologic treatments. Thus in GAD, a disorder that is often suboptimally responsive to traditional psychotherapeutic and psychopharmacologic interventions – secondary to poor efficacy, tolerability, and/or side-effects – pregabalin may have a primary role in GAD patients, especially in those with certain psychiatric comorbidities or individuals who are on multi-drug regimens for medical comorbidities.

Keywords: GAD, pregabalin, panic attack, anxiety disorders, antidepressant, anxiolytic