Which medications in the drug class Anticonvulsant are used in the treatment of Anxiety Disorders?

Updated: Mar 27, 2019
  • Author: Nita V Bhatt, MD, MPH; Chief Editor: David Bienenfeld, MD  more...
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Answer

Anticonvulsant

The drug of choice in this category is the gamma-aminobutyric acid derivative pregabalin (Lyrica).However, caution is necessary when prescribing (prescribe the smallest amount with fewest refills), as it is a Schedule V medication due to the possibility of drug diversion and drug dependence and has a “street value” to drug addicts. Some anticonvulsant medications, such as divalproex (Depakote) and gabapentin (Neurontin), may have a role in the treatment of anxiety disorders, especially in patients with high potential for abusing benzodiazepines.

Pregabalin (Lyrica)

Structural derivative of GABA. Mechanism of action unknown. Binds with high affinity to alpha2-delta site (a calcium channel subunit). In vitro, reduces calcium-dependent release of several neurotransmitters, possibly by modulating calcium channel function. FDA approved for neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia and as adjunctive therapy in partial-onset seizures.

Gabapentin (Neurontin)

Membrane stabilizer, a structural analogue of inhibitory neurotransmitter gamma-amino butyric acid (GABA), which paradoxically is thought not to exert effect on GABA receptors. Appears to exert action via the alpha(2)delta1 and alpha(2)delta2 auxiliary subunits of voltage-gaited calcium channels

Has apparent anxiolytic properties.

Divalproex (Depakote, Depakote ER)

Has proven effectiveness in treating and preventing mania. Classified as a mood stabilizer and can be used alone or in combination with lithium. Useful in treating patients with rapid-cycling bipolar disorders and has been used to treat aggressive or behavioral disorders. A combination of valproic acid and valproate has been effective in treating persons in manic phase, with a success rate of 49%.


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