Xanax (alprazolam) and Gabapentin are two medications that may be prescribed for anxiety, but they function differently and have distinct uses and risks. Xanax is a benzodiazepine designed to quickly address acute anxiety or panic attacks, while Gabapentin, an anticonvulsant, is sometimes used off-label for ongoing anxiety as well as nerve-related pain.
Xanax works by increasing GABA activity in the brain, which calms the nervous system. Its effects are felt within minutes, making it useful for sudden or intense episodes of anxiety. It is often prescribed for acute anxiety situations such as panic attacks, agoraphobia, generalized anxiety disorder (GAD), and specific events like flying or stressful meetings. However, Xanax carries a risk of dependency and withdrawal symptoms if used long-term or stopped abruptly. Common side effects include drowsiness, memory problems, confusion, dizziness, and a potential for misuse.
Gabapentin is approved primarily for nerve pain and seizures but can be prescribed off-label to manage chronic anxiety. Unlike Xanax, Gabapentin modulates calcium channels in the brain to reduce nerve excitability. It does not provide immediate relief; instead, its benefits develop over days or weeks. Gabapentin’s side effects may include drowsiness, dizziness, vision problems, nausea, swelling of extremities, headache, and tremors. The risk of dependency with Gabapentin is lower than with Xanax but still present.
A key distinction between the two drugs lies in their onset time: Xanax acts within minutes whereas Gabapentin requires consistent use over several days to take effect. This makes Xanax more suitable for acute episodes and Gabapentin better for persistent symptoms or cases where there are concerns about substance misuse.
“Xanax is normally chosen when the anxiety is sudden or paralyzing. This is commonly taken before situations that are known to trigger anxiety for some including flying, crowded spaces or public speaking. Xanax works at the same receptors as alcohol and therefore must be given with caution to someone who has a history of substance dependence. Gabapentin is a better option for anxiety treatment for a patient who has a substance dependence history. It is also more likely to be prescribed for persistent anxiety as opposed to sudden anxiety attacks,” said Talkspace therapist Dr. Dion Metzger.
Choosing between these medications should involve careful consideration of personal health history and treatment goals in consultation with a medical professional.
“Xanax is not intended for long-term or regular use in the treatment of anxiety. It serves as a short-term solution for acute symptoms. For ongoing management, a daily medication such as an SSRI or SNRI is typically preferred, as these work to prevent anxiety from occurring rather than simply providing temporary relief,” added Dr. Dion Metzger.
Both medications require prescriptions and supervision from licensed healthcare providers due to their potential side effects and risks associated with misuse or abrupt discontinuation.
Talkspace offers access to licensed psychiatrists who can help patients evaluate their options regarding medications like Gabapentin and Xanax alongside other treatments such as therapy.