Doctors should be aware that psychiatric symptoms may occur following sudden withdrawal from the drug pregabalin. Medical and pharmacy staff do not always realise that pregabalin should not be stopped suddenly unless there are compelling reasons, such as severe allergy. Doses should be carefully reduced by tapering, while paying close attention to the possibility of withdrawal symptoms.
Patients with no previous psychiatric history have developed psychotic symptoms following sudden withdrawal from this medication. Symptoms described in one report included severe insomnia, anxiety, dyspnoea, marked depression, loss of appetite and attempted suicide [1]. The authors of this report also undertook a systematic review of 6 cases and found that 5 of the 6 patients developed psychopathological symptoms, including delusions and hallucinations. Only three of the six patients had previous psychiatric histories [1].
Previous reports on pregabalin withdrawal have mainly focused on patients with pregabalin dependence or abuse. Little attention has been paid to patients on standard doses given for reasons such as nerve pain, anxiety or epilepsy.
Pregabalin withdrawal symptoms may occur after a short period of use and at a variety of ages. Patients may not be easily diagnosed as they may hide their symptoms. Doctors may also focus on other causes for psychiatric symptoms, including age, infection, lack of sleep in hospital together with previous medical conditions, dementia or psychiatric illnesses. Although these possible causes must be considered, doctors and pharmacy staff need to be aware of the risk of psychiatric symptoms following sudden withdrawal from pregabalin.