Question: What are anticonvulsants, how do they work, and are they helpful in the treatment of anxiety disorders?
Answer: Anticonvulsants comprise a very large family of medications, all with a common goal of preventing seizure activity in the brain. And they do this by a number of different mechanisms. The action which is probably well beyond the scope of this presentation -- suffice it to say that these medications work by blocking different neurotransmitters, binding to different receptors, and altering ion channels in the brain, so a number of different mechanisms of action.
What we have found is that there are properties of anticonvulsants that actually make them useful in psychiatric disorders as well, including anxiety disorders. And the problem with this is that there have not been really enough well done large controlled studies to actually give us definitive evidence that they're helpful. So there are currently no anticonvulsive medications that actually carry an FDA indication for the treatment of anxiety disorders. That being said, there have been some preliminary studies done that's shown some benefit for a couple anticonvulsants in the treatment of some specific anxiety disorders.
One is pregabalin, or Lyrica, which has shown some preliminary evidence to be beneficial in generalized anxiety disorder and social anxiety disorder. Another is gabapentin or Neurontin, which has shown some preliminary evidence in social anxiety disorder. And then the other is lamotrigine, or Lamictal, which has shown some very preliminary evidence in the treatment of the posttraumatic stress disorder. That being said, there really need to be further, larger controlled studies to show much more evidence that these medications are helpful and these disorders. And really until that happens, they should be reserved for use only in people who haven't responded to the first line standard treatments for these anxiety disorders such as SSRI antidepressants, benzodiazepines, or buspirone.