Gabapentin for Anxiety Disorders: An Off-Label Treatment

Gabapentin for Anxiety – Gabapentin is a medication that was approved by the FDA in 1993 as an accessory treatment for epileptic seizures. It has actually since obtained approval for the treatment of partial seizures in grownups and kids. In addition to its system as an antiepileptic medicine, Gabapentin functions as an analgesic, and was accepted in 2004 for the treatment of neuropathic discomfort.

In spite of its approved usages as an antiepileptic as well as analgesic, it is typically recommended off-label for a variety of problems. In fact, some resources assume that almost 90% of Gabapentin prescriptions are off-label. In 2004, Pfizer (supplier of Gabapentin) settled for $430 million in a legal action relating to aggressive advertising of the medicine for off-label objectives.

Regardless of the settlement outcome, Gabapentin (brand “Neurontin”) is still typically suggested for a selection of off-label problems consisting of: fibromyalgia, chronic discomfort, bipolar disorder, alcohol withdrawal, as well as migraine frustrations. Probably among the even more appealing off-label makes use of for Gabapentin is for the therapy of anxiety conditions. There is mounting evidence that Gabapentin may be a reliable treatment for numerous sorts of stress and anxiety consisting of: generalised anxiousness condition, social stress and anxiety problem, and panic disorder.

Gabapentin for Anxiety Conditions: The Research study

There is significant study recording the efficacy as well as safety and security of Gabapentin for anxiety problems. Research as well as interest in Gabapentin started in the 1990s for anxiousness problems because of its unique GABAergic mechanism of activity. Nearly every released research study has actually found Gabapentin to be exceptional in efficiency for the decrease of anxiousness when compared to a sugar pill.

1999: Gabapentin has been researched since the 1990s for its impact as an anxiolytic representative. A randomized, placebo-controlled, double-blind research was carried out to establish the safety and efficiency of Gabapentin among people detected with social anxiety condition. A total of 69 participants were split right into two groups: one received Gabapentin (900 mg to 3600 mg daily) as well as the various other obtained a sugar pill.

The research was performed over a period of 14 weeks. Scientist kept in mind that social anxiety degrees plunged among those taking the Gabapentin compared to the placebo. Social stress and anxiety levels were interpreted by medical professional evaluations and also patient score scales. Adverse effects were extra prevalent amongst those getting the Gabapentin compared to the sugar pill– consisting of dizziness, dry mouth, as well as nausea or vomiting.

Authors of the research recommend that based on the minimal data, Gabapentin has a positive risk-benefit ratio for the treatment of social anxiety condition. Also in the 1990s, there was notable evidence to recommend that Gabapentin may be a beneficial intervention for anxiety– specifically social subtypes.

2002: In one study evaluating the effectiveness of Gabapentin as an accessory therapy for bipolar disorder, it was found that renovations were most significant on anxiety-somatization actions of the Hamilton Score Range for Anxiety (HAM-D). Results of the research recommend that those with bipolar disorder who obtained the most take advantage of Gabapentin had either comorbid panic disorders and/or a background of alcoholic abuse.

This highlights the fact that Gabapentin might give most alleviation to people with bipolar disorder that have actually comorbid stress and anxiety. Along with acting as an anxiolytic agent, Gabapentin may also enhance mood using antidepressant mechanisms. The dosage of Gabapentin provided in this research varied from 600 mg to 2400 mg.

It is challenging to draw generalised verdicts from the results of this study, however the outcome shows that Gabapentin may be effective among individuals with panic disorder. Though the medicine hasn’t been checked particularly for the therapy of panic attack, extra research could be necessitated.

2003: Many people experience substantial anxiety throughout public speaking. For this reason, researchers chose to check the impact of Gabapentin on anxiety set off by public speaking tasks. A total of 32 males between the ages of 17 and also 30 joined the research.

Researchers made use of a simulated public speaking (SPS) task to assess both degree of anxiousness and state of mind of the participants. The Visual Analogue Mood Range (VAMS) and Account of Mood State (POMS) were self-evaluated during the simulated public speaking (SPS) task. Additional recordings of physical arousal were recorded through heart rate and high blood pressure.

Participants took either 400 mg Gabapentin or 800 mg Gabapentin. Scientist kept in mind that those taking 800 mg experienced significant decreases on the VAMS scale. Individuals taking Gabapentin at both 400 mg and also 800 mg experienced considerable reductions in hostility scores as determined by the POMS range.

Results from this research study provide extra proof to sustain the anxiolytic results of Gabapentin. Those prone to anxiety associated with public speaking have the tendency to experience remarkable reductions when taking Gabapentin. The decrease in anxiousness related to public speaking could likewise have carryover effects for people with stress and anxiety in social situations.

2005: Because of that Gabapentin has both analgesic and anxiolytic properties, researchers assumed that management of Gabapentin prior to a surgical procedure would certainly reduce anxiety as well as give post-surgery pain relief. To test their hypothesis, they hired 40 people scheduled for arthroscopic knee surgery. Of these 40 clients, they were randomly appointed to get Gabapentin (1200 mg) or a sugar pill.

The management of either Gabapentin or the placebo took place approximately 2 hours before surgical treatment. Outcomes recommended that anxiousness scores prior to operation (preoperative anxiety) were significantly lower amongst those administered Gabapentin compared with the sugar pill group. In addition, those getting Gabapentin required less post-surgical morphine compared to the sugar pill group.

Authors concluded that management of Gabapentin can mitigate preoperative stress and anxiety as well as supply postoperative discomfort alleviation. This highlights the fact that Gabapentin might be an optimum medication for the decrease of both anxiety as well as discomfort connected with knee surgery.

2008: One more study carried out examined the impacts of Gabapentin, morphine, and also diazepam on a rodent model of HIV. Scientist performed this research as a result of that neuropathy is generally related to anti-retroviral therapy. On top of that, anti-retroviral therapy is believed to possibly set off anxiety-like habits.

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To get a far better understanding of exactly how numerous pharmaceutical representatives affect neuropathic pain and also comorbid anxiety-like behavior, they examined: 30 mg/kg Gabapentin as well as 2.5 mg/kg morphine compared with diazepam 1 mg/kg. The impact of Gabapentin and morphine wasn’t significantly different from diazepam. All treatments significantly reduced anxiety-like habits in HIV version rats.

2009: From 2005 to 2007, researchers at Eastern Virginia Medical College determined to check the efficacy of Gabapentin as well as Tiagabine for the therapy of social anxiousness. Scientist determined it would be beneficial to record the security and efficacy because of the fact that many people with social anxiousness do not respond well to typical therapy choices (e.g. SSRIs). Gabapentin works various compared to SSRIs in that it generates GABAergic impacts instead of serotonergic.

To evaluate the effectiveness of Gabapentin and also Tiagabine for the treatment of social anxiousness problem, researchers hired 8 grown-up individuals (21 to 39 years of ages). All participants had actually been identified with social anxiousness disorder in conformity to DSM-IV standards and had scores going beyond 30 on the Liebowitz Social Anxiousness Range (LSAS). The study was thought about double-blind and also randomized.

At the start of the research study, participants were designated to obtain Gabapentin (1800 mg) or Tiabagine (2400 mg). All individuals were titrated approximately the abovementioned doses over a duration of 2 weeks. At numerous 2-week intervals, stress and anxiety levels were analyzed among the people with the Liebowitz Social Stress And Anxiety Range (LSAS).

Outcomes recommended that both Gabapentin as well as Tiagabine considerably lowered social anxiousness according to the Liebowitz Social Anxiousness Range procedures. Two of the subjects accomplished total remission and also 4 reported considerable decreases in stress and anxiety. Side effects connected with either treatment were taken into consideration minimal.

Although this was a really small-scale research, it gives additional proof highlighting the efficiency of Gabapentin for social anxiousness. Researchers also noted that both Gabapentin and Tiagabine may have positive negative effects accounts over traditional first-line options like SSRIs and benzodiazepines.

2012: To better recognize the effects of Gabapentin on anxiety, amnesia, as well as sedation– scientists set up a randomized, placebo-controlled study. They assumed that administration of Gabapentin (1200 mg) prior to surgical treatment (2 to 3 hours) would minimize preoperative stress and anxiety. Their additional hypothesis was that administration of Gabapentin would generate sedation, without memory disability.

A total of 64 medical patients were included in the research study, 32 of whom were designated to get Gabapentin (1200 mg) and also the other 32 of which were offered a placebo. Measures of stress and anxiety, sedation, as well as amnesia were determined prior to medicine, 2 hours after management, and also following their surgical procedure. These were collected with the complying with respective ranges: Spielberger State-Trait Stress And Anxiety Inventory (STAI), Visual Analogue Range Anxiousness (VAS), as well as Snodgrass and also Vanderwart.

The results of the research study suggested substantial reductions in stress and anxiety amongst those receiving Gabapentin as compared to the sugar pill– especially on the State-Trait Anxiety Inventory. No differences were reported in between those obtaining Gabapentin as well as those getting a sugar pill in terms of sedation and also memory. Writers wrapped up that Gabapentin at 1200 mg can considerably minimize anxiousness without harming memory and/or triggering significant sedation.

2012: A magazine from 2012 recognized that Gabapentin is generally used as an off-label therapy for anxiety problems. However, they noted that there wasn’t sufficient medical proof to support the off-label use of Gabapentin for anxiety. To get a better idea of Gabapentin’s effectiveness in regards to treating stress and anxiety, scientists set up a randomized, double-blind, placebo-controlled test.

This test was carried out with 420 bust cancer cells patients that had actually finished radiation treatment. The group of 420 individuals were randomly designated to among 3 groups that received: 300 mg Gabapentin, 900 mg Gabapentin, or a sugar pill. Prior to the research, their anxiety (“attribute” and also “state”) were determined via the Spielberger State-Trait Stress And Anxiety Inventory (SSTAI).

Procedures of both “state” and also “attribute” anxiousness were accumulated after 4 weeks of therapy, and after 8 weeks of treatment. Outcomes of the research study suggested that those receiving Gabapentin, regardless of whether the dose was 300 mg or 900 mg, had considerably reduced “state” anxiousness scores compared to the placebo group. This considerable decrease in “state” stress and anxiety was noted after 4 weeks as well as kept throughout 8 weeks.

Scientists did note that those receiving the 300 mg (lower dose) had better therapy outcomes for the majority of individuals, except among individuals with high standard levels of anxiousness. Writers of this research ended that Gabapentin may be considered a reliable alternate therapeutic representative to standard benzodiazepines for the therapy of stress and anxiety amongst breast cancer survivors.

2013: A research released in 2013 compared the efficiency of Gabapentin and melatonin on steps of: anxiousness, pain, sedation, and specialist complete satisfaction complying with cataract surgery. A total of 130 people were consisted of in the research as well as varied from 35 to 85 years of age. All had actually intended on getting cataract surgical procedure, as well as researchers designated the clients to obtain either: Gabapentin (600 mg), Melatonin (6 mg), or a sugar pill.

These were provided around 90 minutes prior to the client was moved to the operating room. Upon administration, scores of anxiety, discomfort, and sedation were videotaped– as was the doctor’s satisfaction with the surgical treatment. Outcomes showed significantly decreased degrees of anxiousness among those getting the Gabapentin (600 mg) or the Melatonin (6 mg) as compared to the sugar pill.

Upon comparison of Gabapentin (600 mg) to the Melatonin (6 mg)– there was no significant distinction in stress and anxiety reduction. Gabapentin was likewise found above the other 2 options in reducing discomfort ratings. Both Gabapentin as well as Melatonin were superior to the sugar pill in stamina of sedation. There was no difference in between the 3 groups in terms of surgical satisfaction as reported by the doctor.

Researchers highlighted that the anxiolytic results of both Gabapentin and also Melatonin were substantial when as compared to a placebo. This supplies some evidence to suggest that Gabapentin may be an efficient off-label anxiolytic option, specifically among those scheduled for surgical procedure.

2013: By 2010, Gabapentin had actually come to be a fairly preferred off-label therapy for anxiousness problems. In spite of some proof suggesting its effectiveness for anxiousness, there was inconclusive evidence in regards to Gabapentin’s effect for the reduction of preoperative anxiousness. The preoperative subtype of anxiousness is related to feeling agitation and dread prior to a surgery.

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To get a far better understanding of whether Gabapentin worked for preoperative anxiety, scientists contrasted Gabapentin (1200 mg) to that of a sugar pill among people with moderate or high levels of preoperative anxiety. The research was carried out from 2009 to 2011 at a medical facility with 50 female patients; 25 were appointed to the Gabapentin as well as the other 25 were assigned to get the placebo.

Anxiety levels were taped at standard utilizing numerous scales including: Spielberger State-Trait Stress And Anxiety Supply (SSTAI), the Discomfort Catastrophizing Range (PCS), Pain Anxiety Signs Range (PASS), and also the Richmond Agitation-Sedation Range (RASS). About 2 hrs complying with administration of either Gabapentin (1200 mg) or the placebo, people rated their stress and anxiety, pain, and also sedation. The brand-new scores were after that taped and also compared with those achieved at the baseline.

Results demonstrated that the 25 clients getting Gabapentin (1200 mg) experienced significant decreases in preoperative anxiety, discomfort, and catastrophizing compared with the placebo. People receiving Gabapentin reported higher degrees of sedation compared to the placebo. Authors concluded that Gabapentin could be a reliable pharmaceutical treatment for individuals with high levels of preoperative anxiety and/or catastrophizing.

Exists Any Proof To Recommend Gabapentin Is Inadequate For Anxiety?

Gabapentin for Anxiety Disorders: An Off-Label Treatment
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Due to the fact that Gabapentin hasn’t already been thoroughly researched especially for the therapy of anxiousness, it is difficult to recommend that it is highly-effective. That stated, a lot of research studies assessing the anxiolytic residential properties of Gabapentin have noted that they are significant when compared with a sugar pill. Most of research assessing Gabapentin’s impact on anxiety is undistinct (in regards to anxiety-subtypes) and also small.

2010: Of all the released study readily available, there seems one research study that discovered Gabapentin inefficient for reducing preoperative anxiety among individuals set up to undergo an operation. In this situation, the operation was that of an overall hip arthroplasty or substitute of the hip joint with an artificial prosthesis.

In the research, 22 clients obtained Gabapentin (600 mg) and also the staying 48 obtained a placebo. Both were carried out around 2 hrs prior to pre-surgical anesthetic. Stress and anxiety was determined at baseline, before surgical procedure, and post-surgery utilizing a Visual Analogue Scale (VAS). Outcomes suggested that anxiousness ratings weren’t considerably various in between those receiving Gabapentin and those obtaining the sugar pill.

Scientist wrapped up that 600 mg of Gabapentin is ineffective for minimizing preoperative anxiousness. This research is contradictory to the searchings for of other researches that have actually located Gabapentin efficient for lowering preoperative stress and anxiety. Nevertheless, most other researches use other measurements for stress and anxiety (in addition to the Visual Analogue Range) and also have used varying dosages of Gabapentin.

Significant inconsistent evidence appears in a 2012 research of 130 grownups going through surgical treatment. In the newer study (with a bigger example size), Gabapentin was effective at the exact same dose of 600 mg in reducing preoperative anxiousness. Possibly this research was as well small-scale, minimal in regards to anxiousness measurement ranges, and/or possibly the sort of operation affected the outcomes. In any type of respect, this study is an outlier in terms of its searching for that Gabapentin cannot minimize anxiousness.

Just How Gabapentin Might Aid Anxiousness (Device of Action)

The device through which Gabapentin elicits an anxiolytic effect is not completely comprehended. It is thought about structurally just like the neurotransmitter GABA. The neurotransmitter GABA is known to produce a calming effect and soothe stress and anxiety; this result appears amongst those who make use of benzodiazepines and various other medications that target GABA. By comparison, Gabapentin does not really bind to GABA receptors.

GABA Synthesis

Instead, Gabapentin is thought to regulate glutamate decarboxylase as well as branched chain aminotransferase. Both glutamate decarboxylase and branched chain aminotransferase are enzymes aiding in the synthesis of GABA. Research study suggests that Gabapentin can increasing synthesis of GABA, which could discuss its anxiolytic homes.

Among people with psychological conditions as well as comorbid anxiety, alcohol dependence, and/or insomnia, Gabapentin has actually been suggested to supply relief as a result of anxiolytic residential properties. These anxiolytic results have been noted as comparable in respect to diazepam (Valium), a preferred benzodiazepine.

Advantages of Using Gabapentin for Anxiety

There might be some advantages associated with making use of Gabapentin for anxiety over various other medications. One of the most remarkable advantage is that Gabapentin has a various mechanism of action compared with standard first-line treatments of anxiety such as serotonergic antidepressants.

Adjunct Treatment: Gabapentin may be handy for some individuals as an accessory treatment. It is commonly utilized as an adjunct anticonvulsant as well as may be an efficient adjunct to an antidepressant for the treatment of anxiety. Additional examination is warranted, but as a result of its special mechanism of activity, it might have synergistic results when made use of with other meds.

Alternative System of Activity: Let’s face it, not everybody responds to standard anxiolytic interventions for the treatment of anxiety. Standard treatments include antidepressants and benzodiazepines. Those that don’t react well to first-line treatments in regards to symptomatic reduction as well as tolerability could want to take into consideration Gabapentin. Gabapentin is believed to operate by enhancing GABA synthesis by regulating enzymes.

Anxiety Reduction: Most research studies recommend that Gabapentin is an efficient therapy for anxiety. Although it hasn’t been officially authorized by the FDA, virtually every research study examining its anxiolytic result has discovered some degree of advantage. In addition, it seems reliable in dealing with a variety of various stress and anxiety subtypes.

Comorbid Neuropathic Discomfort: Those with anxiety and also comorbid neuropathic discomfort (or vice-versa) could benefit dramatically from Gabapentin. It is medically authorized as well as thought about effective for numerous kinds of neuropathic discomfort, and preliminary evidence recommends that it decreases stress and anxiety. As a result individuals with anxiety and also comorbid neuropathic discomfort could obtain substantial gain from Gabapentin.

Possible State of Mind Increase: There is some proof to suggest that some individuals really feel much less clinically depressed when they take Gabapentin. Although its mechanism of activity isn’t well-understood, it might boost state of mind among those with anxiety or depressive features.

Adverse Effects: The adverse effects profile is considered marginal as well as may agree with compared with other anxiolytic medications. Typical negative effects associated with Gabapentin include: wooziness, control problems, eye activities, as well as shakes. Because of that no weight gain or considerable sex-related dysfunction is reported– Gabapentin could be liked over SSRIs.

Weight Neutral: It appears as though Gabapentin is a “weight neutral” drug because weight gain or loss is unusual for most of users. While weight variations might take place in some individuals, the majority of users will maintain a standard weight throughout treatment.

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Disadvantages of Using Gabapentin for Anxiety

There are additionally some remarkable negative aspects related to utilizing Gabapentin for the treatment of anxiousness. The most noticeable drawback is that there typically aren’t adequate large-scale, targeted research studies to suggest Gabapentin is an effective anxiolytic.

Children/ Teens: The majority of research of Gabapentin for anxiety has actually been conducted in grown-up populaces. This means that the drug may not provide the very same degree of efficacy amongst kids and adolescents. There may also be a risk associated with the GABAergic mechanisms impacting developing brains of those under the age of 25.

Restricted Evidence: There is certainly some proof to suggest Gabapentin may supply remedy for signs and symptoms of anxiousness. Nevertheless, this proof is limited to fairly small sample sizes. There have not been any type of long-lasting, detailed scientific tests assessing the result of Gabapentin for specific types of anxiety.

Long-Term Impacts: The long-term effects related to Gabapentin are unidentified. Despite cases that the drug may be safe when utilized over a long-term, users should be cynical of potential long-term memory problems and/or cognitive disability as a result of GABAergic impacts. Medications like benzodiazepines are connected to dementia, and Gabapentin is thought to act similarly to Diazepam (Valium).

Off-Label: It is estimated that roughly 9/10 prescriptions for Gabapentin are “off-label” or for conditions that the drug isn’t authorized to treat. Off-label prescriptions have a minimize possibility of actually benefiting the treatment of anxiety. This additionally implies that Gabapentin will certainly be harder to obtain a prescription for if you exclusively have anxiousness.

Suspicious Efficacy: Because of the lack of concentrated study specifically assessing Gabapentin’s effect for the treatment of anxiety, its effectiveness needs to be considered suspicious. It can not be globally recommended till much more comprehensive research study is carried out with larger sample sizes over a longer duration.

Unapproved: The FDA has not authorized Gabapentin for the therapy of anxiety. Currently the medicine is accepted for the therapy of epilepsy (as a complement) and also neuropathic discomfort. Any type of use other than both approved problems could not offer relief.

Withdrawal: A lot of doctor consider Gabapentin withdrawal signs and symptoms to be reasonably small or missing. Little do they recognize that the discontinuation impacts can be incapacitating as well as protracted– lasting for a long-term. The withdrawal ought to not be ignored, some people claim that discontinuation of Gabapentin is as severe as virtually other neurochemistry-altering medication.

Optimum Usage of Gabapentin for Anxiety: Who is most likely to profit?

Specific individuals could obtain even more benefit from using Gabapentin for their anxiousness compared to others. Not everyone with anxiousness is going to locate Gabapentin therapeutic; numerous individuals report experiencing no considerable modification in their level of anxiety as a result of treatment.

Anxiety Subtypes: Certain anxiety subtypes could respond much better to Gabapentin compared to others. Particularly situations of anxiety that are caused or influenced by neuropathic discomfort could respond much better to Gabapentin. Additionally, anxious subtypes stemming from GABAergic dysfunction could stand to benefit more from this drug considering that it controls GABA synthesis.

Anxiety: While Gabapentin is not an antidepressant, there is subtle proof recommending that it might boost state of mind. It might be particularly practical at maintaining mood as a complement when prescribed for bipolar affective disorder. Some studies suggest that the mood-boosting impact stemmed from Gabapentin for bipolar clinical depression is an outcome of dealing with anxiousness and altering GABAergic neurotransmission.

Medicine Withdrawal: In choose situations, this medicine could be prescribed to assist combat stress and anxiety and various other signs of drug or alcohol withdrawal. Many of the signs and symptoms associated with alcohol withdrawal result from dysfunction in GABAergic neurotransmission. Some guess that short-term use of Gabapentin could reduce hard discontinuation from various other medications.

Epilepsy: Those with epileptic seizures could obtain recommended Gabapentin as a complement treatment. Should a private with epilepsy likewise suffer from stress and anxiety, they might locate that this medication provides them with some added relief– helping them remain calm.

Hot Flashes: One more fairly common off-label problem that may take advantage of Gabapentin is that of hot flashes. Hot flashes are in some cases associated with excess stress and anxiety and anxiousness. Lots of unscientific records have actually recommended that Gabapentin is effective for the reduction of hot flashes.

Migraine Headaches: The medicine has actually had off-label success as a prescription to target migraine headaches. While it isn’t really approved to minimize frustrations, numerous anecdotal reports recommend that it is an efficient option. Those with migraines and also anxiety or stress and anxiety so negative that migraines follow, Gabapentin could give some relief.

Neuropathic Discomfort: The medication is approved for the treatment of neuropathic discomfort, and if you have actually been identified with this condition, it could be recommended as a first-line therapy. As an added benefit, you might discover that it’s likewise aiding to reduce your anxiousness. Consider the anxiety decrease as an added advantage of the medicine.

Poor Reaction To First-Line Treatments: People with refractory situations of anxiety that don’t react to first-line therapies like antidepressants might wind up attempting Gabapentin. As a result of the fact that it has a mechanism of activity that differs from the majority of treatments indicates that there’s a chance it may provide some relief in a manner that an additional drug can not.

Surgical Procedure: Those getting surgery could take advantage of Gabapentin as a pre-surgical therapy to assist decrease preoperative stress and anxiety as well as reduce post-surgical discomfort. There is installing proof to validate cases that Gabapentin is an efficient medicine to be used on a short-term basis for clients obtaining surgical treatment.

Have You Made Use of Gabapentin For Anxiety?

If you have individual experience making use of Gabapentin, did you see a significant reduction in anxiousness while taking it? Did you particularly take Gabapentin with the intention of treating stress and anxiety or did you take it for an approved problem such as epileptic seizures and/or neuropathic pain? Don’t hesitate to share your experience in the remarks area below.

To help others obtain a precise understanding of your Gabapentin use, be sure to document the dosage that you took, how much time you’ve been taking it, and whether you experience a sustained anxiolytic effect. Recognize that the efficacy may undergo specific variation as well as details subtype of anxiousness (e.g. social, generalized, preoperative, etc).

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