Pregablin for treatment of generalized anxiety disorder

 

Generalized anxiety disorder (GAD) is characterized by excessive and inappropriate worrying that is persistent (lasting more than a few months) and not restricted to particular circumstances.

Patients have physical anxiety symptoms and key psychological symptoms, including restlessness, difficulty concentrating, irritability, muscle tension, and disturbed sleep.

Patients with GAD have the same concerns about health, family, relationships, work, and finances as non-anxious controls but have a greater number of worries over minor matters.

However, most patients present with other symptoms; many complain of poor sleep and difficulty in relaxation, but recurrent headaches and various aches and pains are also common.

Some patients present repeatedly to health professionals, with pressing but long-standing physical symptoms that prove to be “medically unexplained”.

There have been considerable advances in the understanding of the presumed mechanism of action of pregabalin underlying its anxiolytic effects.

Pregabalin is a branched chain amino acid, similar in structure to leucine and GABA.

However, it does not appear to bind to the GABA receptor, or to any binding site allosterically linked to GABA, or to the GABA transporter, or to enzymes involved in the synthetic or metabolic pathways of GABA.

It is absorbed rapidly after oral administration and achieves maximal plasma concentrations within 1-hour.

The findings of randomized controlled trials and meta-analyses together indicate that pregabalin is efficacious in both acute treatment and relapse prevention in GAD, with some evidence of an early onset of effect, and broad efficacy in reducing the severity of psychological and physical symptoms of anxiety.

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