Gabapentin in the Management of Meal-time Anxiety in Restrictive Eating Disorders

ObjectivesFew psychotropic medications have shown efficacy in treating eating disorders during the acute weight restoration phase, with olanzapine being the primary option despite its side effect profile. This study is the first to show that gabapentin may aid in eating disorder management, demonstrating objective improvements in meal completion and weight gain, as well as subjective relief of pre-meal anxiety and post-meal gastrointestinal distress. MethodsYouth (N=14) enrolled in partial hospital treatment from 2020 to 2025 who received gabapentin for mealtime anxiety and poor meal completion were identified via chart review. Extracted data included demographics, comorbidities, and subjective/objective treatment response measures (e.g., meal completion rates). As mealtime anxiety was not universally documented, a control group was not feasible. Meal completion was assessed at three time points: two weeks prior, the day of initiation, and two weeks post-initiation. Analyses included paired t-tests, Hedges G for effect size, and the sign test for subjective response data. ResultsGabapentin was most commonly dosed (n=8) at 300mg scheduled before meals. There were statistically significant subjective responses for preprandial anxiety (86%), postprandial abdominal discomfort (57%), and early satiety (50%). Meal completion improved by an average of 36% two weeks after initiation, compared to 2.5% in the two weeks prior (p =.002, g = 1.14). Among the nine youth who were nasogastric tube-dependent, the improvement was even greater at 52.5% (p =.003, G = 1.5). Both of these effect sizes were large. ConclusionsDespite limitations in methodology and sample size, this case series strongly suggests that gabapentin may be a promising option for managing mealtime anxiety and improving intake in youth with eating disorders. With the particularly notable effects in NGT-dependent youth and those with poor response to olanzapine in this study, gabapentins potential in eating disorder management warrants further exploration.