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Drug Info

Gabapentin for bipolar

There’s limited evidence on the effectiveness of gabapentin for bipolar disorder
Gerardo Sison medical writer headshot
By | Jan. 10, 2025
A pencil with a smily face flag attached to one side and a sad face flag attached to the other: Gabapentin for bipolar

Key takeaways

  • Gabapentin is not FDA approved for bipolar disorder, and studies show limited evidence of its effectiveness for this purpose. 

  • While it may help with symptoms like anxiety and insomnia, gabapentin’s benefits for bipolar disorder are inconclusive. 

  • Gabapentin can cause side effects such as drowsiness and dizziness and may interact with other medications.

  • Gabapentin dosages for bipolar disorder are not standardized, and insurance generally doesn’t cover it for this use.

In this article:

Gabapentin, known by the brand name Neurontin, is a drug that’s sometimes prescribed for uses beyond what it’s approved for. For example, although it’s approved by the Food and Drug Administration (FDA) to treat seizures and nerve pain, it may be prescribed off-label for chronic muscle pain (fibromyalgia), generalized anxiety disorder, and alcohol withdrawal, among other uses. 

While some researchers suggest gabapentin may help with bipolar disorder, the truth is a bit more complicated. It is not FDA approved for treating mood disorders like bipolar disorder, and studies on its effectiveness for this condition have been largely inconclusive. In fact, much of the push for using gabapentin for bipolar disorder is based on aggressive marketing tactics from the manufacturer, Pfizer, which eventually led to legal action against them.

How does gabapentin work for bipolar?

Gabapentin is a prescription drug that belongs to a class of medications called anticonvulsants. This medication, along with another drug called pregabalin, is further classified as a gabapentinoid. In other words, it’s similar in structure to a natural chemical in the brain called GABA, which plays a role in calming nerve activity. 

Gabapentin helps manage nerve pain from shingles and prevents seizures by affecting how nerve signals are sent in the body, specifically by blocking certain calcium channels in nerve cells. For seizures, it’s typically prescribed as an adjunctive therapy or an additional treatment that works together with other medications to help control seizures better.

Research indicates that people with bipolar disorder have increased calcium activity in specific cells, suggesting that calcium channels are involved in the condition. Gabapentin is thought to target these calcium channels to help lower the release of certain brain chemicals that lead to mood swings. Although researchers have seen how gabapentin works in both animals and people with conditions like pain and epilepsy, there is still not enough evidence to show that it’s effective for treating bipolar disorder.

Benefits and drawbacks of gabapentin for bipolar disorder

Some healthcare providers may prescribe gabapentin for bipolar disorder due to potential perceived benefits. While some people may experience positive effects, there can also be negative effects or side effects to consider.

Potential benefits of gabapentin for bipolar disorder

Gabapentin may help people with bipolar disorder in some ways by improving mental health symptoms like irritability, social withdrawal, and anxiety. It may also help with insomnia due to its sedative effects. 

The drug also has a relatively safe side effect profile compared to other medications. It also doesn’t interact with many other drugs, which may be helpful for people on multiple medications.

Disadvantages of gabapentin for bipolar disorder

The evidence for gabapentin in bipolar disorder is limited. It hasn’t been found to be better than a placebo for acute mania, and multiple studies have shown gabapentin to be ineffective for bipolar disorder overall. In addition, adjunctive gabapentin is often used alongside other medications, which means that any benefits people notice could actually be due to those other drugs instead of gabapentin itself. This might raise doubts about how well gabapentin works as monotherapy or on its own.

One systematic review looked at six randomized controlled trials and 13 open-label trials to determine the effectiveness of gabapentin and pregabalin for the treatment of bipolar disorder. The findings showed these medications likely do not provide significant benefits for managing bipolar disorder, especially during manic episodes. Many of the studies had small sample sizes and included flawed trial designs, which may have affected the reliability of the results. 

Although it’s relatively safe to use, gabapentin may still cause side effects. Therefore, the medication’s drawbacks may outweigh the potential benefits for some people.

Gabapentin dosage for bipolar

There is no official dosage of gabapentin for bipolar disorder since this is an off-label use. However, for its FDA-approved uses like postherpetic neuralgia, the typical starting dosage is 300 mg on day one, increasing to 600 mg on day two and 900 mg on day three. The dosage can be increased up to 1,800 mg per day if needed. 

For treating epilepsy with partial onset seizures, adults and children 12 years and older usually start with 300 mg taken three times a day, which can be increased to 600 mg. For children ages 3–11 years, the starting dose is based on weight, typically between 10–15 mg per kilogram per day, divided into three doses. 

Gabapentin dosage in studies on bipolar disorder

Some studies on gabapentin for bipolar disorder have tested dosages ranging from 600–3,600 mg per day. However, gabapentin was often given alongside other medications like Eskalith (lithium) or Depakene (valproate or valproic acid). A few clinical trials also studied dosages of up to 4,800 mg daily. Still, research has not shown clear benefits for bipolar symptoms at any dosage level.

The dosage of gabapentin for bipolar disorder will depend on a healthcare provider’s instructions and expertise. Typically, treatment begins with a low dose, which may be gradually increased until the desired effects are achieved. In any case, it could take a few weeks to experience any potential benefits of gabapentin for bipolar disorder. 

Gabapentin side effects, warnings, and interactions with other bipolar drugs

Gabapentin can cause several side effects, many of which are mild and temporary. However, some side effects may be severe. 

Common side effects of gabapentin include: 

  • Drowsiness 
  • Dizziness 
  • Lack of coordination 
  • Nausea and vomiting
  • Trouble speaking
  • Fatigue
  • Fever
  • Blurred or double vision

Because gabapentin can cause drowsiness and dizziness, it’s important not to drive or use heavy machinery before being accustomed to its effects. The drug should not be stopped suddenly, due to an increased seizure risk. 

More serious adverse effects may occur. These can include suicidal thoughts or actions, changes in behavior or mood, and allergic reactions affecting the skin or organs. Seek immediate medical attention if you experience thoughts of suicide, unusual changes in mood or behavior, skin rash, difficulty breathing, or severe fatigue.

Gabapentin interactions to keep in mind

Gabapentin may interact with various medications. For example, taking gabapentin and opioid pain medicines together may cause severe drowsiness or slowed breathing. Drowsiness and dizziness may also be amplified while taking other central nervous system (CNS) depressants, such as benzodiazepines and antihistamines. Additionally, gabapentin may interact with antacids, potentially reducing its effectiveness.

Gabapentin vs. other treatments for bipolar disorder

Bipolar disorder can be treated through various medications and other interventions. However, it’s best to consult a healthcare provider for the most appropriate option due to potential side effects. 

Mood stabilizers

Mood stabilizers are one of the main types of medications for bipolar disorder. Lithium, for example, is often considered the gold standard for treating bipolar disorder. It helps prevent both manic and depressive episodes. 

Besides lithium, other mood stabilizers include:

These medications are anticonvulsants, which means they’re used to treat seizures in addition to stabilizing mood. Some mood stabilizers may be approved for treating different aspects of bipolar disorder. For example, valproic acid is approved to treat manic episodes of bipolar disorder, while lamotrigine can treat both mania and bipolar depression in adults. 

Atypical antipsychotics

Atypical antipsychotics are another treatment option for bipolar disorder. They can help manage manic episodes and some types of bipolar depression. 

Common atypical antipsychotics for bipolar disorder include:

These medications may help reduce symptoms like racing thoughts, agitation, and psychosis. Antipsychotics may also help improve mood and make it easier for people to go about their daily lives. However, they may differ in how they’re used. For example, Seroquel is approved for manic and depressive episodes, while Latuda is only approved for depressive episodes. 

Antidepressants

Antidepressants are sometimes used to treat bipolar depression. But they’re used carefully because they can trigger manic episodes in some people.

Common antidepressants used include:

  • Selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine), Zoloft (sertraline), and Lexapro (escitalopram)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Effexor (venlafaxine), Cymbalta (duloxetine), and Pristiq (desvenlafaxine)
  • Wellbutrin (bupropion)

Healthcare providers typically prescribe antidepressants with a mood stabilizer to lower the risk of triggering mania. Some antidepressants may have a higher risk of causing mania than others. For example, SNRIs are more likely to cause mania than SSRIs. 

Therapy

Therapy may be another aspect of bipolar disorder treatment that may be recommended alongside medication to improve symptoms. Cognitive-behavioral therapy (CBT) is often used to help people manage their thoughts and behaviors and reduce the severity of mood episodes.

Interpersonal and social rhythm therapy focuses on creating daily routines and improving relationships, which may help prevent mood swings. In addition, family-focused therapy involves loved ones in treatment to improve family communication and support.

Will insurance cover gabapentin for bipolar?

Insurance coverage for gabapentin in bipolar disorder is often limited. Most health plans don’t cover it for this use because the FDA hasn’t approved gabapentin to treat bipolar disorder. As a result, gabapentin may need to be paid out of pocket if it’s prescribed for bipolar symptoms. However, if you have bipolar disorder along with a comorbidity like epilepsy or nerve pain that is approved for treatment with gabapentin, your insurance may cover it for that other condition.

How to save on gabapentin

Without insurance, a quantity of 90 generic gabapentin capsules can cost around $152. However, there are several ways to save on your gabapentin prescription:

  • SingleCare gabapentin coupons may help reduce the cost of gabapentin to as low as $7 for a 30-day supply at participating pharmacies. No sign-up or eligibility requirements are needed to use SingleCare’s free drug coupons, which could save you up to 80% on your prescription.
  • If you’re prescribed a brand-name version of gabapentin, such as Neurontin or Gralise, patient assistance programs may be available through the drug manufacturer. These programs typically have eligibility criteria based on income, insurance status, and other factors. Check the manufacturer’s website or search online for available programs to learn how to apply.
  • Comparing prices at different pharmacies may also help you find the lowest cost for your gabapentin prescription. Prices can vary between pharmacies, so it often pays to shop around.

By using free prescription discount cards, comparing prices, and exploring patient assistance programs, you may be able to reduce your out-of-pocket costs for gabapentin without insurance.