There is no drug that treats FND itself. But medications are often prescribed to manage the co-occurring symptoms that make FND harder to live with — pain, anxiety, tremor, and POTS. Here is what is most commonly discussed, and what the evidence says about each.
For a full breakdown of each medication — mechanisms, evidence, side effects, what to tell your neurologist before starting, and 17 questions to bring to your appointment — read the FND Medication Guide. This page is the at-a-glance summary.
Neuropathic-type pain and troublesome sensory symptoms are among the most common reasons a person with FND sees a neurologist. The dominant category here is antiepileptic drugs (AEDs) — gabapentinoids such as gabapentin and pregabalin, plus topiramate — repurposed for neuropathic pain and migraine prophylaxis in FND.
A gabapentinoid originally developed for epilepsy, now mainly used for neuropathic pain. May help with burning, stabbing, or electric-shock sensations in FND. UK Class C controlled drug; dependence risk with prolonged use.
Antiepileptic with good evidence for migraine prophylaxis. Considered when migraine co-occurs with FND at high rates. Notable side effect: cognitive slowing (sometimes called "Dopamax"). Teratogenic.
Depression, anxiety, and PTSD are common comorbidities in FND. Medications that treat these conditions — particularly SNRIs like duloxetine, which also help with centralised pain — are among the most frequently prescribed.
Selective serotonin reuptake inhibitors (sertraline, fluoxetine, citalopram). Strong evidence for depression and anxiety in general populations. Limited FND-specific efficacy data, but widely prescribed because of high comorbidity.
Serotonin-noradrenaline reuptake inhibitors. Better evidence than SSRIs for neuropathic pain and central sensitisation. Often preferred when both mood and pain are prominent.
Tricyclic antidepressants sometimes used for neuropathic pain, migraine prophylaxis, and co-occurring depression. Notable anticholinergic burden (dry mouth, constipation, urinary retention), pronounced sedation, and cardiac conduction cautions — especially in overdose. Start low, go slow.
NICE recommends limiting benzodiazepine use to 2–4 weeks because of dependence and tolerance. They are not a long-term FND treatment and should be reviewed at every prescription.
A long-acting benzodiazepine occasionally prescribed for acute anxiety, panic attacks, or significant muscle spasm. NICE guidance cautions against use beyond 2–4 weeks due to dependence risk. Not a long-term FND treatment.
POTS (postural orthostatic tachycardia syndrome) co-occurs with FND at higher rates than in the general population, and functional tremor often has an adrenergic component. Beta-blockers and mineralocorticoids address both.
Non-selective beta-blocker. Moderate evidence for essential tremor and POTS; widely used for physical anxiety symptoms such as racing heart and shaking. Contraindicated in asthma.
Longer-acting non-selective beta-blocker. Off-label alternative to propranolol when once-daily dosing is preferred. Similar effect on POTS and adrenergic tremor.
Synthetic mineralocorticoid that increases blood volume. Moderate evidence for managing POTS — reduces lightheadedness and tachycardia on standing, which can in turn reduce FND symptom burden.
Up to 1 in 5 people with epilepsy also have dissociative (non-epileptic) seizures. Antiepileptic drugs are appropriate only when true co-occurring epilepsy has been confirmed by video EEG telemetry.
A commonly prescribed antiepileptic. Evidence does not support its use for dissociative seizures in the absence of confirmed co-occurring epilepsy. If you have been prescribed it, clarify with your neurologist whether you have confirmed epilepsy that justifies its use.
Opioids are generally not recommended for FND by leading neurology bodies. Specialist consensus suggests opioids may worsen central sensitisation and perpetuate symptom cycles. If you are currently prescribed an opioid, discuss this with your neurologist — do not stop independently.
A quick comparison of the eight medication classes most commonly discussed in the context of FND. "Limited" does not mean unhelpful — it means FND-specific randomised controlled trial data are lacking.
| Medication | Symptom Target | Evidence | Main Risks |
|---|---|---|---|
| Gabapentin | Neuropathic pain, sensory symptoms | Limited in FND | Sedation, dependence, Class C (UK) |
| SSRIs / SNRIs | Depression, anxiety, pain sensitisation | Moderate (comorbidities) | Initial activation, GI effects, discontinuation |
| TCAs (amitriptyline, nortriptyline) | Depression, neuralgia, migraine prophylaxis | Limited in FND | Anticholinergic effects, cardiac conduction, sedation, overdose toxicity |
| Propranolol | Tremor, POTS, anxiety | Moderate (tremor/POTS) | Bradycardia, contraindicated in asthma |
| Clonazepam | Acute anxiety, muscle spasm | Limited (short-term) | Dependence; avoid long-term use |
| Topiramate | Migraine prophylaxis, pain | Limited in FND | Cognitive slowing, teratogenic |
| Fludrocortisone | POTS, postural hypotension | Moderate (POTS) | Fluid retention, electrolyte imbalance |
| Nadolol | POTS, tremor | Limited in FND | Bradycardia, contraindicated in asthma |
| Levetiracetam | Co-occurring epilepsy only | Not recommended for PNES | Mood changes, irritability |
Before any new prescription is filled, a short structured conversation with your prescriber protects you from avoidable interactions, helps you set a clear baseline for comparison, and reduces the chance of being left without a review plan. CalmCircuit can directly support step 2 below — a baseline symptom diary entry before the medication starts makes the before-and-after comparison honest.
Use these tiers as a quick triage guide. When in doubt, err toward calling — your neurology team would rather hear from you early than miss something time-sensitive.
For the complete breakdown — mechanisms, side effects, what to tell your neurologist before starting, and 17 questions to bring to your next appointment — read FND Medications: What Neurologists Prescribe, What the Evidence Says, and What to Ask.
CalmCircuit lets you log dose changes, side effects, and symptom response day by day — so when an adjustment is on the table, you show your neurologist objective data instead of relying on memory. Particularly valuable during the titration window described in the checklist above.
Start your symptom journal free →This article is for informational purposes only and does not constitute medical or prescribing advice. Medication decisions must be made with a qualified neurologist or GP who knows your full clinical history. Do not start, stop, or alter doses of any medication without clinical guidance. If you are experiencing a medical emergency, call 999 (UK) or your local emergency services.