Alcohol withdrawal. Multiple studies have shown gabapentin to be effective in the treatment of alcohol withdrawal. In one double-blind, dose-response RCT, 100 participants with CIWA-Ar scores of 10 or greater were randomized to receive either gabapentin 900mg/day for three days, followed by gabapentin 600mg/day on the fourth day; gabapentin 1,200mg/day for three days, followed by gabapentin 800mg/day on the fourth day; or lorazepam 6mg/day for three days, followed by lorazepam 4mg/day on the fourth day. CIWA-Ar scores decreased over time in all groups, with the high-dose gabapentin group showing a statistically superior (p=0.009), though clinically similar, response, compared to the lorazepam group. Furthermore, those treated with gabapentin had less craving (as measured by Visual Analogue Scales [VASs]), anxiety (measured by the Zung Anxiety Scale), and sedation (measured by the Epworth Sleepiness Scale) compared to lorazepam, and had less probability of drinking (measured by the Timeline Followback) during post-treatment follow-up. Another RCT of 26 patients with alcohol withdrawal compared treatment with gabapentin 1,200mg/day tapered down to 300mg/day over six days to chlordiazepoxide 100mg/day tapered down to 25mg/day over six days. CIWA-Ar scores averaged 7.7 (gabapentin) and 8.8 (chlordiazepoxide) at baseline and declined gradually and similarly in both groups, with the gabapentin group experiencing less sedation toward the end of the seven-day trial, as measured by the Epworth Daytime Sleepiness Scale. This study was limited by its small sample size. A retrospective cohort study examined 50 patients who received high-dose gabapentin (≥1,800 mg/day) in the first 48 hours of hospital admission and compared them to 50 propensity-score matched patients who did not receive gabapentin. This study found that patients who received high-dose gabapentin for severe alcohol withdrawal required significantly less total amount of benzodiazepines (mean±standard deviation [SD]: 109.5±53.4mg vs. 88.5±35.6mg [lorazepam equivalents], p=0.023) and had a significantly lower mean CIWA-Ar score (10.1±4.7 vs. 7.7±3.9, p=0.010) compared to those who did not receive gabapentin. These findings are challenged by a RCT in which 61 patients, who all received a symptom-triggered regimen of clomethiazole, were randomized to receive either gabapentin 1,600mg/day or placebo in a seven-day trial. There was no significant difference in the amount of clomethiazole required in the first 24 hours between groups, nor was there a significant difference in level of alcohol withdrawal symptoms in the first 48 hours. It should be noted that there is an absence of evidence showing gabapentin being effective for delirium tremens or withdrawal seizures in alcohol withdrawal, except for one retrospective cohort study of adults admitted to the hospital for alcohol withdrawal syndrome. This study categorized patients into a gabapentin group, a benzodiazepine group, and a combination group and found no statistical differences among incidence of seizure, intensive care unit (ICU) transfer, or delirium tremens., Gabapentin is a nerve pain medication and anticonvulsant that has proven to be effective for people who have hard-to-treat depression or other mood disorders., This article reviews evidence-based psychiatric uses of gabapentin, along with associated risks. An extensive literature review was conducted, primarily of articles searchable in PubMed, relating to psychiatric uses, safety, and adverse effects of .