Antidepressants in epilepsy

Abstract

People with epilepsy (PWE) frequently suffer from comorbid mood and anxiety disorders. Depression is one of the major psychiatric comorbidities having a negative impact on the quality of life in people with epilepsy. A review of the literature indicates that the majority of antidepressant-related seizures have been associated with either ultra-high doses or overdosing and, generally, the risk of antidepressant-associated seizures is low. Correspondingly, there is some evidence indicating that antidepressants of most widely used groups may additionally lower the risk of triggering seizures. Four antidepressants are not recommended for patients with epilepsy, i.e.: amoxapine, bupropion, clomipramine and maprotiline. Clinicians applying first line of depression treatment in patients with epilepsy should consider use of SSRIs or SNRIs, particularly sertraline, citalopram, mirtazapine, reboxetine, paroxetine, fluoxetine, escitalopram, fluvoxamine, venlafaxine, duloxetine. Implementation of anticonvulsive drugs in depressed patients should include valproate, carbamazepine, lamotrigine, gabapentin, pregabalin. The paper reviews the evidence for the clinical use of antidepressants in PWE.

Is escitalopram safe to use as an antidepressant in epilepsy patients?

“…SSRIs are a widely used type of antidepressant in the treatment of depression. Most studies have reported that SSRIs and antidepressants have antiepileptic effects on various experimental epilepsy models (24,25). For instance, in our published article, vortioxetine (5 and 10 mg/kg), a novel SSRI, suppressed epileptiform activity in the pentylenetetrazole (PTZ)-induced kindling model (15).…”

Psychiatric comorbidities in epilepsy patients: results of a Tunisian study

“…However, tricyclic or tetracyclic antidepressants and norepinephrine-dopamine reuptake inhibitors should be avoided as the first choice due to their capacity to lower the seizure threshold. 33 A review of the literature indicates that maprotiline, high doses of clomipramine and amitriptyline (>200mg) and high doses of bupropion immediate-release formulation (>450mg) seem to be more frequently associated with seizures than other antidepressants. 34 Our study has several methodological limitations.…”

Avaliação de efeitos preliminares do plumierídeo após administração oral a camundongos

“…Somado a isso, a perda da "resiliência" da rede neuronal poderia explicar o surgimento da crise. Os principais fatores epigenéticos relacionados às alterações de sinalização nas redes neuronais são a inflamação, estresse, drogas, e até mesmo os antidepressivos tricíclicos (AVANZINI et al, 2012;CHANG et al, 2018;GÓRSKA et al, 2018;MOSHÉ et al, 2014). A pesquisa acerca dos processos convulsivos e fármacos com novos mecanismos de ação, torna-se indispensável devido às controversas bases da fisiopatologia.…”