None of the other anticonvulsants have much evidence for anxiety and typically are only used as last line treatments in complex polypharmacy to manage a range of disorders. They also tend to have significantly worse side effects. The only other anticonvulstant that I would touch for anxiety is gabapentin but I don't expect it would be as effective.
There are plenty of on license medications that come with less side effects and a fair few effectively on license (those that are prescribed either or to replace those on license). Benzo's should be avoided unless its absolutely necessary and if you are trying to avoid the side effects of sleepiness etc they will be worse than the Pregabalin. You could always try adding something stimulating to pregabalin but I wouldn't recommend it (Modafinil is likely the best choice). Before you look at anything else spreading the dose throughout the day as is standard may be more useful taking three smaller dosages instead of one at night.
In part it depends on what disorder you suffer from as to which meds are best chosen and that's disregarding the use of psycho-social interventions which apart from OCD are often more effective - in particular for panic disorder.
Panic disorder is best treated by a combination of SSRI's (paroxetine, Sertraline or fluoxetine are best) and CBT (sometimes IPT is appropriate) with a short course of Benzo's if required.
Generalized anxiety disorder is best treated by SSRI's (paroxetine, Sertraline or fluoxetine are best), SNRI's, Buspirone or Pregabalin and CBT (sometimes IPT is better).
OCD tends to be more treatment refractory. Psycho-social interventions tend to stand between remission and 'under-control' but often more complex drug combinations need to be used alongside longer psychotherapy 12-16 sessions of CBT (with a focus on behavioral interventions). OCD respond almost souly to Serotonergic drugs - Escitalopram being the only truly Serotonergic drug is typically chosen first. If that fails higher than suggested doses is normally recommend 30-50mg or a switch to Sertraline at 200-400mg. Following that either the addition of low dose sedating atypical antipsychotics, Mirtazapine or switching to clomipramine. The addition of Pregabalin, Buspirone or a switch to Venlafaxine are also valid but less evidence based options. In the most severely treatment resistant cases combinations like Clomipramine, and any two of Pregabalin/Buspirone/L-Tryptophan/Trazadone/Mirtazapine/AAP's/Escitalopram and as needed Clonazepam (up to 5mg/day) are combined with long term CBT (50 or more sessions) or hospitalization with a focus on CBT. Sometimes Phenalzine is used (often in combination with Aripirpazole or Quetiapine).
I would recommend you get yourself 6-12 sessions of CBT alongside starting Escitalopram/Sertraline (waiting 2-4/8 weeks) and then reducing the Pregabalin slowly.
Where as GAD and Panic Disorder tend to start to respond to SSRI's and the like in the normal time frame (2-4 weeks) OCD can take 12+ weeks before significant improvements are seen.
Edited by Tom_, 13 December 2013 - 11:24 PM.
