Risk of seizures associated with psychotropic medications: emphasis on new drugs and new findings

Abstract

Psychotropic medications in the classes of antidepressants, antipsychotics and mood stabilisers have been recognised in the literature and clinical settings as having high epileptogenic potential. Among these three classes, clozapine, tricyclic antidepressants (TCAs) and lithium are agents that clinicians have historically recognised as precipitants of drug-induced seizures. There are few reports that review the epileptogenic risk of newer psychotropic agents; in this qualitative review, the authors provide an update on the most recently published reports on seizures associated with antidepressants, antipsychotics, mood stabilisers, anxiolytics and sedative-hypnotics. In general, the epileptogenic risks of the newer psychotropic agents appear to be quite low as long as dosing strategies are consistent with recommended guidelines. Whilst newer psychotropic medications appear to be safe in patients with epilepsy, few studies have specifically addressed this population. In addition, the potential for drug interactions between antiepileptic drugs and psychotropics may be substantial with certain agents. For example, many psychotropes are both substrates and inhibitors of cytochrome P450 (CYP450) isoenzymes, whilst many antiepileptic drugs are both substrates and inducers of CYP450 activity. Every attempt should be made to minimise potential interactions when these agents are concomitantly administered.

Safety and tolerability of duloxetine in the treatment of major depressive disorder: analysis of pooled data from eight placebo‐controlled clinical trials

“…In some studies, seizure incidence rates have been reported to range from 0.1% to 1.5% in patients treated with therapeutic doses of antidepressants and antipsychotics (compared with an incidence in the general population of 0.07% to 0.09%) (Pisani et al, 2002;Lee et al, 2003). Within the eight clinical trials in the present study, one patient receiving duloxetine (0.1%) reported a seizure.…”

Women with epilepsy: clinically relevant issues

“…The findings of most studies suggest that judicious use of psychotropic medication outweighs the risk of reducing the seizure threshold (Kanner, 2008). There is limited evidence to help clinicians in the choice of psychotropic medications in patients with epilepsy, and there does not seem to be enough evidence to restrict the use of any medication apart from clozapine in this vulnerable patient group (Lee et al, 2003). It has been shown that low starting doses and slow titration can be helpful in maximizing the therapeutic potential and reducing the risk of adverse effects.…”

Zotepine-induced convulsive seizures in a chronic case of treatment resistant paranoid schizophrenia

“…[4] The fatal adverse events observed with zotepine were neuroleptic malignant syndrome, abnormal ECG, paralytic ileus, and convulsive seizure (s). [5] Zotepine induced seizure has been only published in few case reports and discrete occasional observational studies[6] and none so far from India. We report myoclonic seizure progressing to generalized tonic-clonic seizures with clear temporal association of dose dependent modulation occurring with zotepine.…”