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Ask Dr. Bob

QUESTION
I have Fibromyalgia, co-occurring with depression and anxiety. I presently take Neurontin; I was originally prescribed it for pain, but now I find myself taking it just to feel good. All the literature indicates Neurontin is not a drug of abuse, and yet I fear I am becoming psychologically and/or physically dependent on it. Can you shed any light on this matter?

ANSWER
Neurontin (gabapentin) was recently introduced as a new anticonvulsant drug (for seizures), and it rapidly began experimental use in Chronic Pain Syndromes, such as Fibromyalgia, and as a mood stabilizer in Depression or Bipolar Disorders (see our "Ask Dr. Bob" answer from July 2003).

Neurontin has also been reported effective for treating alcohol withdrawal, not surprisingly since this is also true of other anticonvulsants (Tegretol for example). To the best of my knowledge, there are no reports of Neurontin being a drug of abuse or dependence. I've also quizzed two addiction-psychiatrists who agreed that this was true.

How then can we explain your feeling the need to take Neurontin to "feel good"? There may be an important difference between what you are terming "feeling good" and what we might worry about as "euphoria" -- an intense high occurring just after consuming an addicting drug! Since you suffer from anxiety and depression, it is quite likely that you have received some therapeutic benefit for these conditions by taking Neurontin. This lessening of depression/anxiety would certainly be a "good feeling" but not akin to the "high" of a potentially addicting drug! Feeling the need for this drug may be to you similar to the need felt by the patient with Major Depression who fears stopping an antidepressant medication as it would be followed by return of a devastating mood change!

So there is a difference between feeling the need for a therapeutic medication and the desire to get "high" on an addicting drug. You may be "psychologically" dependent on Neurontin, but it may not be harmful and not similar to substance abuse.

Thanks for introducing an important and sometimes confusing difference in use of the term "dependence."

Dr. Bob



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Disclaimer

Dr. Bob does not provide specific medical advice or a medical diagnosis for any particular condition described, nor verify the authenticity of any information described in the questions presented. Patients should always consult their physician to discuss any specific symptoms, conditions, or modes of therapy for any particular mental or physical difficulties, diseases or conditions.

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