FND Medications: What Neurologists Prescribe, What the Evidence Says, and What to Ask

Most people with FND are eventually offered a medication — not to treat the underlying condition, but to manage something that co-occurs with it: chronic pain, anxiety, a postural tremor, or the dizziness of POTS. Understanding what you are being offered, and why, puts you in a much better position to work with your clinical team.

This guide covers the eight medication classes most commonly discussed in the context of FND, based on current specialist guidance. It is written for patients and carers — clinically careful, but in plain language.

Important before you continue: medications are one small part of FND treatment. Specialist physiotherapy and CBT remain the most evidence-based interventions for FND itself. Medications treat comorbidities — they do not replace rehabilitation.

Why Medications Don't "Treat" FND — and What They Do Instead

FND has no approved pharmacotherapy. The condition arises from disrupted brain networks governing movement, sensation, and attention — and no drug has yet been shown to reliably correct that disruption.

What medications can do is reduce the comorbid symptoms that make FND harder to manage. Chronic pain, for example, raises the body's threat-detection system — which can amplify FND symptoms. Treating the pain does not cure FND, but it removes a significant aggravating factor. The same logic applies to anxiety, depression, postural tachycardia, and migraine.

A note on opioids

Opioids are not recommended for FND by leading neurology bodies. Specialist consensus — including guidance from the FND Society — suggests that opioids may worsen central sensitisation and perpetuate symptom cycles in functional disorders. They also carry significant risks of dependence and tolerance. If you are currently prescribed an opioid for pain alongside an FND diagnosis, discuss this with your neurologist before making any changes to your prescription.

Evidence Overview: 8 Medication Classes at a Glance

The table below summarises the eight medication classes most commonly encountered by people with FND. Evidence levels reflect current specialist guidance — "limited" does not mean a medication is unhelpful, only that large FND-specific randomised controlled trials are lacking.

Gabapentin — Neuropathic Pain and Sensory Symptoms

Gabapentin (brand name Neurontin) is a gabapentinoid — a class of drug originally developed as an antiepileptic but now used primarily for neuropathic pain and certain types of sensory disturbance.

It works by binding to calcium channels in the central nervous system, reducing the release of excitatory neurotransmitters. This dampens overactive pain signalling pathways.

Who may be prescribed it in FND?

Neurologists may consider gabapentin when a person with FND experiences significant neuropathic-type pain (burning, stabbing, electric-shock sensations), troublesome sensory symptoms, or allodynia (pain from normally non-painful touch). It is not prescribed to treat FND's core movement or dissociative symptoms.

What the evidence says

Gabapentin has moderate evidence for neuropathic pain in general populations, but robust FND-specific randomised controlled trial data are lacking. Its use in FND is therefore largely extrapolated from evidence in related pain conditions. Population-level studies have not established gabapentin as an effective treatment for the functional neurological symptoms themselves.

Common side effects:

• Drowsiness and sedation (often most pronounced when starting)
• Dizziness and coordination difficulties
• Weight gain
• Memory and concentration difficulties
• Peripheral oedema (ankle swelling)

Note on controlled drug status: In the UK, gabapentin is a Schedule 3 / Class C controlled drug. This affects how it is prescribed and dispensed.

What to tell your neurologist before starting gabapentin

• Any history of substance use disorder
• Current kidney problems (dose adjustment may be needed)
• Other sedating medications you take (risk of additive sedation)
• Whether you drive (sedation may impair driving ability)
• If you are pregnant or planning pregnancy

Clonazepam — Anxiety and Muscle Spasm

Clonazepam is a benzodiazepine — a class of drugs that enhance the activity of the inhibitory neurotransmitter GABA, producing a calming effect on the central nervous system. It has antiepileptic, anxiolytic, and muscle-relaxant properties.

In the context of FND, it may occasionally be prescribed for acute or severe anxiety, panic attacks, or significant muscle spasm. Its use in FND is not standardised and varies considerably between clinicians and clinical settings.

What the evidence says

Robust FND-specific evidence for clonazepam is very limited. Benzodiazepines as a class have well-established short-term anxiolytic effects, but their evidence base does not extend to treating the core features of FND. Their use in FND is off-label and should be considered carefully.

Dependence and withdrawal: what you need to know

Benzodiazepines carry a recognised risk of physical dependence with prolonged use. UK NICE guidance cautions against prescribing benzodiazepines for longer than two to four weeks in most circumstances. Stopping benzodiazepines abruptly after a period of use can cause withdrawal effects, which may be severe. Any decision to start, continue, or stop clonazepam must be made with your prescribing neurologist or GP — never alter your dose independently.

Common side effects:

• Sedation and drowsiness
• Impaired coordination and balance
• Memory difficulties
• Paradoxical agitation in some individuals
• Physical dependence with prolonged use

What to tell your neurologist before starting clonazepam

• Any history of substance use disorder or previous benzodiazepine use
• Other medications that affect the central nervous system
• Whether you drive (benzodiazepines impair driving ability)
• Whether you are pregnant or breastfeeding
• What the planned duration and taper plan is

Propranolol — Tremor, POTS, and Anxiety

Propranolol is a non-selective beta-blocker — it blocks the effects of adrenaline (epinephrine) on beta-adrenergic receptors in the heart, blood vessels, and other tissues. It has been used for decades for conditions including high blood pressure, angina, essential tremor, and anxiety-related physical symptoms.

In the context of FND and its common comorbidities, propranolol may be considered for: functional tremor (where an adrenergic component is suspected), POTS (postural orthostatic tachycardia syndrome — which frequently co-occurs with FND), and physical symptoms of anxiety such as a racing heart and shaking.

What the evidence says

Propranolol has moderate evidence for essential tremor generally, and moderate evidence for POTS management. Evidence specifically for functional tremor in FND is more limited, but the physiological rationale is well-established. Some clinicians report useful symptom reduction in patients with a significant adrenergic or autonomic component to their FND presentation.

Common side effects:

• Fatigue and reduced exercise tolerance
• Cold extremities
• Slow heart rate (bradycardia)
• Vivid dreams or sleep disturbance
• Dizziness on standing

What to tell your neurologist before starting propranolol

• Any history of asthma or respiratory conditions (beta-blockers are contraindicated in asthma)
• Heart rate or rhythm problems
• Diabetes (beta-blockers can mask hypoglycaemia symptoms)
• Other blood pressure medications
• Whether symptoms are worse on standing (POTS needs a specific assessment)

SSRIs and SNRIs — Depression, Anxiety, and Pain Sensitisation

Selective serotonin reuptake inhibitors (SSRIs — such as sertraline, fluoxetine, and citalopram) and serotonin-noradrenaline reuptake inhibitors (SNRIs — such as duloxetine and venlafaxine) are antidepressants that work by increasing the availability of serotonin (and noradrenaline in SNRIs) in the brain's synapses.

In FND, they may be prescribed when depression, anxiety, or PTSD are identified as significant comorbidities — which is common. SNRIs, particularly duloxetine, are also used for neuropathic pain and central sensitisation, where they have better evidence than for FND specifically.

What the evidence says

SSRIs and SNRIs have strong evidence for depression and anxiety disorders. Evidence for their direct effect on FND symptoms is limited — a 2010 trial (LaFrance et al.) showed some benefit of sertraline for non-epileptic seizure frequency, but subsequent evidence has been mixed. They remain widely prescribed in FND because of the high co-occurrence of mood disorders, not because of proven FND-specific efficacy.

Common side effects:

• Nausea (often resolves in the first two weeks)
• Initial increase in anxiety or agitation (usually temporary)
• Insomnia or vivid dreams
• Sexual side effects
• Discontinuation effects if stopped abruptly (particularly with venlafaxine)

What to tell your neurologist before starting an SSRI or SNRI

• Any previous antidepressant use (and whether it helped or caused problems)
• Any history of bipolar disorder (SSRIs can trigger hypomania)
• Other medications that affect serotonin (risk of serotonin syndrome)
• Any bleeding tendencies or anticoagulant use (SSRIs affect platelet function)
• If you are pregnant or planning pregnancy

Topiramate — Migraine Prophylaxis and Pain

Topiramate is an antiepileptic drug with a broad mechanism of action — it affects sodium and calcium channels, enhances GABA activity, and inhibits glutamate. Its primary uses in the UK are epilepsy and migraine prevention.

In FND, topiramate may be considered if migraine is a significant comorbidity (migraine is disproportionately common in FND populations) or when pain sensitisation is a prominent feature that has not responded to other approaches.

What the evidence says

Topiramate has good evidence for migraine prophylaxis in general populations, and moderate evidence for certain pain conditions. Its evidence base specifically for FND symptoms is limited. It is not a first-line agent for FND and is generally only considered when a specific comorbidity (most often migraine) justifies it.

Common side effects:

• Cognitive slowing and word-finding difficulties (sometimes called "Dopamax" by patients)
• Appetite suppression and weight loss
• Kidney stones (requires adequate fluid intake)
• Paraesthesia (tingling sensations, usually in hands and feet)
• Mood changes

Important: Topiramate is teratogenic (harmful to a developing fetus) and is contraindicated in pregnancy. Anyone who could become pregnant should discuss contraception with their prescribing clinician before starting topiramate.

What to tell your neurologist before starting topiramate

• Whether you are pregnant, planning pregnancy, or need reliable contraception
• Any history of kidney stones
• Whether cognitive side effects would be particularly problematic for your work or daily activities
• Any history of glaucoma

Levetiracetam — Co-Occurring Epilepsy Only

Levetiracetam (brand name Keppra) is an antiepileptic drug that works through a distinct mechanism — binding to the synaptic vesicle protein SV2A, which modulates the release of neurotransmitters. It is commonly prescribed for epileptic seizures.

In the context of FND, levetiracetam sometimes appears in medication lists because FND and epilepsy can coexist in the same person — a situation that requires careful diagnostic separation. The critical point for people with functional (dissociative) seizures specifically is that levetiracetam is not an appropriate treatment for non-epileptic seizures on their own.

What the evidence says

Evidence does not support levetiracetam as a treatment for dissociative (non-epileptic/functional) seizures in the absence of confirmed co-occurring epilepsy. Prescribing antiepileptic drugs for non-epileptic seizures can lead to unnecessary medication burden, side effects, and may delay engagement with appropriate treatment (physiotherapy and CBT). If you are prescribed levetiracetam, clarify with your neurologist whether you have confirmed co-occurring epilepsy.

Common side effects:

• Irritability and mood changes (can be significant for some patients)
• Fatigue
• Headache
• Behavioural changes, particularly in children and adolescents

What to tell your neurologist before starting levetiracetam

• Whether your seizures have been confirmed as epileptic by video EEG telemetry
• Any history of depression or mood disorders (mood side effects can be significant)
• If you have kidney problems (dose adjustment may be required)
• If you are pregnant or planning pregnancy

Fludrocortisone — POTS and Postural Hypotension

Fludrocortisone is a synthetic mineralocorticoid — it mimics the action of aldosterone, a hormone that regulates sodium and water retention in the kidneys. By increasing blood volume, it can improve blood pressure and reduce the symptoms of postural hypotension and POTS.

POTS (postural orthostatic tachycardia syndrome) is a dysautonomia that co-occurs with FND at higher rates than in the general population. Symptoms — lightheadedness, racing heart on standing, fatigue, brain fog — can significantly overlap with and worsen FND symptoms.

What the evidence says

Fludrocortisone has moderate evidence for managing POTS. Its use in FND is indirect — it treats the POTS, which may in turn reduce the autonomic symptom burden that worsens FND. It is not used to treat functional neurological symptoms themselves.

Common side effects:

• Fluid retention and ankle swelling
• Elevated blood pressure
• Electrolyte imbalance (particularly low potassium — potassium supplementation is sometimes needed)
• Headache

What to tell your neurologist before starting fludrocortisone

• Any history of high blood pressure or heart conditions
• Any kidney problems
• Whether you have POTS confirmed by a tilt table test or other autonomic assessment
• Other medications (particularly those affecting blood pressure)
• If you are pregnant or breastfeeding

Nadolol — POTS and Tremor (Off-Label)

Nadolol is a non-selective beta-blocker with a longer duration of action than propranolol. Like propranolol, it blocks the effects of adrenaline on beta-adrenergic receptors, reducing heart rate and blood pressure.

In FND, nadolol is used off-label as an alternative to propranolol when once-daily dosing is preferred, or when patients have not responded well to propranolol. Its target symptoms are the same: POTS, tremor with an adrenergic component, and physical anxiety symptoms.

What the evidence says

The evidence base for nadolol in FND specifically is limited. It is used based on extrapolation from propranolol data and general beta-blocker evidence in POTS and essential tremor. Clinical use is driven by individual patient factors and prescriber experience rather than FND-specific trial data.

Common side effects:

• Fatigue
• Bradycardia (slow heart rate)
• Cold hands and feet
• Dizziness on standing

What to tell your neurologist before starting nadolol

• Any history of asthma or respiratory conditions (contraindicated)
• Heart rate or rhythm problems
• Whether you are already taking other blood pressure medications
• Diabetes (beta-blockers can mask hypoglycaemia signs)

Tracking Side Effects When You Have FND

One of the particular challenges of starting a new medication when you have FND is that side effects can be very difficult to distinguish from FND symptoms themselves. Fatigue, cognitive difficulties, dizziness, and sensory changes are both common side effects and common FND symptoms. This makes it genuinely hard to know whether something that changes after starting a medication is a drug effect or natural variation in FND.

Keeping a structured symptom log in the weeks before and after starting any new medication gives you objective data to bring to your next appointment. What to track:

• Timing of dose — when you took it relative to symptom changes
• Symptom onset and offset — when new symptoms appeared and whether they resolved
• Severity on a 1–10 scale — consistent scoring makes patterns visible
• Whether the symptom was pre-existing — separating new symptoms from familiar ones
• Functional impact — how much the symptom affected daily activities

17 Questions to Ask Your Neurologist About a New Medication

Being prepared for medication discussions makes your clinical appointments more productive. Here are questions that cover the most important areas — feel free to bring this list to your next appointment.

1. What specific symptom or comorbidity is this medication targeting in my case?
2. Is this medication specifically licensed for FND, or is it being used off-label?
3. What does the evidence actually say for this medication in FND or in my target symptom?
4. What are the realistic goals — what improvement should I expect, and over what timeframe?
5. Are there alternative medications I could try, and how does this one compare?
6. How will this medication interact with my current physiotherapy or CBT programme?
7. What dose will I start on, and how will it be titrated upwards?
8. What side effects should I watch for in the first two weeks specifically?
9. Which side effects should prompt me to contact you immediately?
10. Does this medication affect my ability to drive?
11. Are there interactions with other medications I take, including over-the-counter drugs?
12. How long will we try this before deciding if it is working?
13. What would stopping this medication look like — does it need to be tapered?
14. Are there implications for pregnancy or contraception I need to know about?
15. Will this medication mask any symptoms I should still be reporting to you?
16. How will I know if this is helping — what should I track or notice?
17. Are there lifestyle factors (sleep, alcohol, exercise) that interact with this medication?