Case Report: the Comorbidity of Pregabalin-Use Disorder and Post-Traumatic Stress Disorder: Clinical and Pharmacological Issues

Owing to its anxiolytic effects, pregabalin is used to treat many distressing symptoms, with various clinical observations supporting its potential benefits in cases of post-traumatic stress disorder (PTSD). However, a decade-long concern has been raised regarding the risk of patient misuse. A 27-year-old immigrant male self-treated with massive doses of pregabalin for at least 6 yr to alleviate his re-experiencing of the past war events he faced in his native country. PTSD and pregabalin-use disorder were diagnosed upon his arrival at our addiction care center. A controlled pregabalin withdrawal failed because the patient switched from this drug to alcohol and methadone available on the street. We therefore organized a hospitalization to provide a controlled methadone delivery and to begin pregabalin withdrawal, enabling thereafter the management of his care to focus on his PTSD. This case report invites clinicians to be cautious in prescribing pregabalin to patients suffering from PTSD, especially to at-risk populations such as migrants. Pregabalin has a positive effect on acute post-traumatic anxiety, but no long-term beneficial impact. As suggested by preclinical studies, pre-existing PTSD could potentiate the development of a pregabalin substance-use disorder.