Psychological Dimensions of Pregabalin Withdrawal in Adolescents: A Comparison Between Amitriptyline and Prazepam
DOI:
https://doi.org/10.46325/42r8gt24Keywords:
Psychological Distress, Drug Withdrawal Syndrome, Substance-Related Disorders, Adolescents, PregabalinAbstract
object:
Pregabalin misuse has increased in recent years, including among adolescents, exposing this vulnerable population to a withdrawal syndrome characterized by marked psychological distress, such as anxiety, irritability, and emotional instability. These symptoms may compromise withdrawal adherence and increase the risk of relapse. Evidence guiding pharmacological management of pregabalin withdrawal in adolescents remains limited. This study compared the effectiveness of prazepam, a long-acting benzodiazepine, and amitriptyline, a tricyclic antidepressant, on withdrawal severity, with particular attention to psychological dimensions.
Methods:
A randomized pilot study was conducted among fifteen adolescent patients (aged 15–18 years) diagnosed with pregabalin use disorder and receiving outpatient care at the addiction unit of Tlemcen University Hospital. Participants were allocated to receive either prazepam (10 mg/day) or amitriptyline (25 mg/day) as part of a medically supervised withdrawal protocol. Withdrawal severity was assessed at baseline and after 30 days using the Subjective and Objective Opiate Withdrawal Scales (EOS/ESS), focusing on both psychological and somatic symptoms.
Results:
Both treatments were associated with a significant reduction in withdrawal severity scores over the 30-day follow-up. However, improvement was significantly greater in the prazepam group (ESS: 39.4 to 14.6; EOS: 3.30 to 0.30) compared with the amitriptyline group (ESS: 39.6 to 24.9; EOS: 2.90 to 1.00), with a statistically significant between-group difference (p < 0.05).
Conclusion:
In adolescents undergoing pregabalin withdrawal, prazepam appears to provide more rapid relief of acute psychological withdrawal symptoms, while amitriptyline remains a relevant non-benzodiazepine alternative for patients presenting prominent affective distress. These findings underscore the importance of integrated pharmacological and psychological approaches tailored to adolescents to improve emotional regulation and reduce relapse risk. Larger controlled studies are warranted to confirm these preliminary results.
References
Bonnet, U., et N. Scherbaum. « How Addictive Are Gabapentin and Pregabalin? A Systematic Review ». European Neuropsychopharmacology, vol. 27, no 12, décembre 2017, p. 1185‑215. DOI.org (Crossref), https://doi.org/10.1016/j.euroneuro.2017.08.430.
Evoy, Kirk E., et al. « Abuse and Misuse of Pregabalin and Gabapentin ». Drugs, vol. 77, no 4, mars 2017, p. 40326. DOI.org (Crossref), https://doi.org/10.1007/s40265-017-0700-x.
Gurjar, Nikhil, et al. « Patterns, Risks, and Clinical Challenges of Pregabalin Misuse in Patients With Opioid Use Disorder: A Case Series ». Cureus, mai 2025. DOI.org (Crossref), https://doi.org/10.7759/cureus.84524.
Hägg, Staffan, et al. « Current Evidence on Abuse and Misuse of Gabapentinoids ». Drug Safety, vol. 43, no 12, décembre 2020, p. 123554. DOI.org (Crossref), https://doi.org/10.1007/s40264-020-00985-6
Handelsman, Leonard, et al. « Two New Rating Scales for Opiate Withdrawal ». The American Journal of Drug and Alcohol Abuse, vol. 13, no 3, janvier 1987, p. 293308. DOI.org (Crossref), https://doi.org/10.3109/00952998709001515.
Kosten, Thomas R., et Patrick G. O’Connor. « Management of Drug and Alcohol Withdrawal ». New England Journal of Medicine, vol. 348, no 18, mai 2003, p. 178695. DOI.org (Crossref), https://doi.org/10.1056/NEJMra020617.
Langlume, Lisa, et al. « Comment prendre en charge le sevrage en prégabaline dans le cadre d’un trouble de l’usage ? » Therapies, vol. 76, no 2, mars 2021, p. 176. DOI.org (Crossref), https://doi.org/10.1016/j.therap.2021.01.039.
Littleton, J. « Neurochemical Mechanisms Underlying Alcohol Withdrawal ». Alcohol Health and Research World, vol. 22, no 1, 1998, p. 1324.
Luo, Yaan, et al. « A case report of pregabalin misuse leading to drug dependence ». Frontiers in Psychiatry, vol. 16, mars 2025, p. 1511168. DOI.org (Crossref), https://doi.org/10.3389/fpsyt.2025.1511168.
Mayo-Smith, Michael F. « Pharmacological Management of Alcohol Withdrawal: A Meta-Analysis and Evidence-Based Practice Guideline ». JAMA, vol. 278, no 2, juillet 1997, p. 144. DOI.org (Crossref), https://doi.org/10.1001/jama.1997.03550020076042
Nunes, Edward V., et Frances R. Levin. « Treatment of Depression in Patients With Alcohol or Other Drug Dependence: A Meta-Analysis ». JAMA, vol. 291, no 15, avril 2004, p. 1887. DOI.org (Crossref), https://doi.org/10.1001/jama.291.15.1887.
Peles, Einat, et al. « Pregabalin Misuse: Motives, Pattern, and Knowledge about Its Risks among Patients in Methadone Maintenance Treatment ». Journal of Psychoactive Drugs, vol. 53, no 3, mai 2021, p. 23846. DOI.org (Crossref), https://doi.org/10.1080/02791072.2020.1861392.
Salehi, Mehrdad, et al. Amitriptyline Efficacy in Control of Acute Opioid Withdrawal Syndrome. Research Article no 6, Koomesh, 30 juin 2005, p. 195-200.e152053. brieflands.com, https://brieflands.com/journals/koomesh/articles/152053#abstract.
Torrens, Marta, et al. « Efficacy of Antidepressants in Substance Use Disorders with and without Comorbid Depression ». Drug and Alcohol Dependence, vol. 78, no 1, avril 2005, p. 122. DOI.org (Crossref), https://doi.org/10.1016/j.drugalcdep.2004.09.004.
Tsai, Guochuan, et Joseph T. Coyle. « The Role of Glutamatergic Neurotransmission in the Pathophysiology of Alcoholism ». Annual Review of Medicine, vol. 49, no 1, février 1998, p. 17384. DOI.org (Crossref), https://doi.org/10.1146/annurev.med.49.1.173.
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