Based on NIH | Is depression a side effect of gabapentin, and how common is it?

Gabapentin can be linked to mood changes, including depression, in a small proportion of people, and there is also a class warning for antiepileptic drugs about an increased risk of suicidal thoughts or behaviors. While most users do not experience depression, it’s important to monitor for new or worsening low mood, anxiety, or suicidal thinking after starting or changing the dose of gabapentin. ^{[1] [2]}

What official safety information says

• U.S. product labeling carries a class warning for antiepileptic drugs (gabapentin included) noting an increased risk of suicidal thoughts or behavior. People taking gabapentin should be alert for the emergence or worsening of depression, any unusual mood or behavior changes, or suicidal thoughts, and report these promptly. ^[1]
• The patient medication guide commonly states that suicidal thoughts or actions may occur in a very small number of people about 1 in 500. This warning also lists “new or worse depression” and “new or worse anxiety” among symptoms that require immediate medical attention. ^[2]
• The pooled analysis that underlies this class warning found roughly a doubling in risk of suicidal thinking/behavior for antiepileptic drugs vs placebo (adjusted relative risk ~1.8), though the absolute risk remains low. This is why labels emphasize vigilant monitoring rather than routine discontinuation. ^{[3] [4]}

How common is depression with gabapentin?

• Precise rates of “depression” as a standalone side effect vary across studies and labels, and are not consistently quantified like the class suicidality estimate. However, official medication guides highlight that serious mood-related events (including depression and suicidal thoughts) are uncommon overall, with suicidality signals around 0.2% (about 1 in 500). ^[2]
• Prescribing information emphasizes monitoring rather than implying that most users will develop depression. In clinical practice, many people take gabapentin without mood worsening, but rare individuals do experience notable mood changes. ^{[1] [4]}

What real‑world and research data suggest

• Large observational data comparing periods before vs after gabapentin prescription did not find an overall increase in suicide attempts; in psychiatric subgroups, rates were numerically lower after starting gabapentin. These findings suggest the drug does not universally raise suicidal behavior risk, though individual responses vary. ^[5]
• Even with such observational findings, the precautionary principle still applies because the class warning is based on pooled randomized trials across antiepileptic drugs. Thus, labels continue to recommend close monitoring for depression and suicidality with gabapentin. ^{[3] [1]}

Who might be at higher risk?

• People with a history of depression, anxiety, or prior suicidal thoughts may be more vulnerable and should be monitored closely when starting or adjusting gabapentin. Caregivers and family should also watch for changes in mood, behavior, or thinking. ^{[1] [4]}

What to watch for

• New or worsening: low mood, loss of interest, anxiety, agitation or restlessness, panic attacks, trouble sleeping, irritability, aggressive or unusual behavior, or suicidal thoughts/behavior. If these occur especially early in treatment or after dose changes contact a healthcare professional right away. ^{[2] [6]}

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Quick reference table

Topic	What the evidence/labels say	Practical takeaway
Suicidal thoughts/behavior risk	Antiepileptics, including gabapentin, may approximately double relative risk vs placebo; absolute risk is low (about 1 in 500 for serious mood symptoms in consumer guides). [3] [2]	Rare but serious; monitor closely and seek help promptly if symptoms emerge.
Depression as a side effect	Listed as “new or worse depression” requiring attention; exact incidence not uniformly quantified in labels. [2] [1]	Possible but uncommon; pay attention to mood changes, especially after starting or dose changes.
Observational outcomes	Large cohort found no overall increase in suicide attempts after starting gabapentin; some psychiatric groups showed reductions. [5]	Population signal may be reassuring, but individual risk remains; continue monitoring.

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Practical tips for safe use

• Start and adjust carefully: Many mood changes, when they occur, happen early after initiation or following dose increases; clinicians often titrate gradually to reduce side effects. Report any concerning mood symptoms promptly rather than waiting for them to pass. ^{[2] [1]}
• Do not stop abruptly: Stopping gabapentin suddenly may cause withdrawal symptoms or worsen the underlying condition; any changes should be guided by a clinician. If severe mood symptoms appear, urgent medical advice is still recommended to plan a safe approach. ^{[4] [1]}
• Coordinate care: If you have a history of depression or anxiety, let your prescriber know before starting gabapentin; extra check‑ins may be helpful. Involving family or close contacts to help monitor for mood changes can improve safety. ^[1]

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Bottom line

Depression can occur with gabapentin, but it appears to be uncommon, and the primary safety signal emphasized in official information is a small but important risk of suicidal thoughts or behaviors seen across antiepileptic drugs. Most people will not experience depression, yet everyone should be monitored for mood changes and seek prompt care if concerning symptoms arise. ^{[2] [3] [1]}