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LETTER TO EDITOR  
Year : 2015  |  Volume : 57  |  Issue : 1  |  Page : 111-112
From benzodiazepine to pregabalin dependence: Different agents, similar problems


Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Ulm University, Ulm, Germany

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Date of Web Publication7-Jan-2015
 

How to cite this article:
Gahr M, Freudenmann RW, Kölle MA, Schönfeldt-Lecuona C. From benzodiazepine to pregabalin dependence: Different agents, similar problems. Indian J Psychiatry 2015;57:111-2

How to cite this URL:
Gahr M, Freudenmann RW, Kölle MA, Schönfeldt-Lecuona C. From benzodiazepine to pregabalin dependence: Different agents, similar problems. Indian J Psychiatry [serial online] 2015 [cited 2019 Dec 5];57:111-2. Available from: http://www.indianjpsychiatry.org/text.asp?2015/57/1/111/148551


Sir,

The literature provides only few plausible case reports of pregabalin (PRG) abuse/dependence. [1],[2],[3],[4] Hence, further data are necessary to identify risk factors for the development of PRG-associated addictive behaviors. Here, we present a further case of a patient with PRG dependence.

The 33-year-old female patient was diagnosed with borderline personality disorder approximately 10 years ago. In addition, the patient showed benzodiazepine (BZP) dependence for more than 3 years, taking between 3 and 6 mg lorazepam per day. Furthermore nicotine dependence was present for more than 10 years. There was no history of alcohol or any other psychotropic substance use. The current readmission in our psychiatric ward was due to increasing family conflicts and, therefore, the patient was admitted for a short crisis intervention. On admission, there was no regular medication. However, the patient reported taking up to 3000 mg PRG per day. She explained to have been prescribed PRG as a PRN medication in the psychiatric out-patient department 7 months ago for the treatment of unspecific anxiety symptoms. During the first applications of PRG (25 mg capsules) she had experienced that the effects of PRG and lorazepam were similar, and thus, she had gradually increased her daily PRG-dose. In return, she had been able to reduce the daily lorazepam-dose. Further on, she figured out that it was easier to receive medical prescriptions for PRG than for lorazepam as she only had to point out to "her anxiety" to get PRG-prescriptions. Finally, she completely abandoned lorazepam and solely used PRG up to 3000 mg/day (up to 6 daily intakes with various doses ranging from 25 to 300 mg). She described that she had a strong desire to take PRG, and she was not able to stop taking it. In order to obtain PRG, she sought prescriptions from at least five different physicians. Her daily business was nearly completely limited to obtaining sufficient amounts of PRG. As subjective effects, occurring about 20-30 min after oral intake of PRG, she reported sedation and euphorization (lasting for about 3-5 h). Although she had increased her PRG-dose in exchange for lorazepam, she reported that these effects were slightly decreasing in intensity and duration since she took PRG alone (for about 5 months). Thus, she had to increase her daily PRG-dose up to 3000 mg/day to maintain the intended effects. The patient was informed about the alleged PRG dependence, and an inpatient detoxification treatment was suggested. However, the patient refused to get her PRG-dose reduced and left the hospital.

In the present case the patient featured tolerance, intake of large amounts of PRG, and spent a great deal of time in activities necessary to obtain PRG, making the patient's addictive behavior appear as PRG dependence according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. As in the other case reports of PRG abuse or dependence, [2],[3] our patient presented a history of substance-related disorders as well. Interestingly, the patient abandoned lorazepam and switched to PRG, underscoring the similarities between BZP and PRG regarding their potential to cause addictive behaviors.

 
   References Top

1.
Filipetto FA, Zipp CP, Coren JS. Potential for pregabalin abuse or diversion after past drug-seeking behavior. J Am Osteopath Assoc 2010;110:605-7.  Back to cited text no. 1
    
2.
Grosshans M, Mutschler J, Hermann D, Klein O, Dressing H, Kiefer F, et al. Pregabalin abuse, dependence, and withdrawal: A case report. Am J Psychiatry 2010;167:869.  Back to cited text no. 2
[PUBMED]    
3.
Gahr M, Franke B, Freudenmann RW, Kölle MA, Schönfeldt-Lecuona C. Concerns about pregabalin: Further experience with its potential of causing addictive behaviors. J Addict Med 2013;7:147-9.  Back to cited text no. 3
    
4.
Carrus D, Schifano F. Pregabalin misuse-related issues; intake of large dosages, drug-smoking allegations, and possible association with myositis: Two case reports. J Clin Psychopharmacol 2012;32:839-40.  Back to cited text no. 4
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Correspondence Address:
Maximilian Gahr
Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Ulm University, Ulm
Germany
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5545.148551

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