Psychiatry and Clinical Psychopharmacology

Substance abuse and dependence Pregabalin dependence: a case report

Psychiatry and Clinical Psychopharmacology 2013; 23: Supplement S254-S255
Keywords : dependence, pregabalin
Read: 527 Published: 17 March 2021

Pregabalin, a gamma-amino butyric acid analogue, is a new generation antiepileptic. In our country, it is allowed to be used at a dose range of150-600 mg/day in neuropathic pain, generalised anxiety disorder, fibromyalgia and as concomittant therapy in adult patients with partial epilepsy. However, in the last years, case reports suggest that pregabalin has a potential for abuse and dependence. A 34-year-old, married male, who applied to our outpatient unit, firstly in july 2013. He had a history of alcohol and poly substance (cannabis and extacy) dependence. After four years of abstinence for alcohol, cannabis and extacy; three years ago, he started to take pregabalin with the suggestion of one of his relatives. He realized that his generalised anxiety, that has been prevalent since his childhood, decreased with pregabalin; thus he increased the dosage. At the date of applying to our unit, his maximum dose of pregabalin was 15.600 mg/day but in overall it was about 1.780 mg/day. He said he felt euphoria with more energy, less need of sleep, lower level of anxiety, grandiosity, and visual hallucinations on high doses of pregabalin; but on the other hand, when he tried to discontinue pregabalin, he felt ‘’deep down’’ with the feelings of pessimism, aggression, anxiety, thoughts of suicide, anergy, anorexia, palpitation, tremor, sweating, vomitting. In psychiatric examination; hypersomnia, anorexia, anergy, depressive mood, anhedonia, anxiety was found out. At the differential diagnosis, according to DSM-IV-TR, Other Substance (Pregabalin) Dependence; Other Substance-Related (Pregabalin) Mood Disorder, With Onset During Withdrawal and Generalised Anxiety Disorder were thought. His Beck Depression score was 43 and Beck Anxiety score was 48. A schedule to reduce pregabalin dose by 150 mg/day was given to the patient. Quetiapine 50 mg/day and bupropion 150 mg/day (gradually going up to 300 mg/day) were added on paroxetine 20 mg/day that was prescribed by another psychiatrist. He was evaluated twice a month and he reported that he discontinued pregabalin without the feeling of “deep down”. The last Beck Depression score was 16 and Beck Anxiety score was 15. Pregabalin is an promising agent in psychiatric disorders. But it should be used carefully in patients with a history of dependence.
 

EISSN 2475-0581