Epilepsy Talk

Antidepressants and Epilepsy | April 24, 2016

For a long time, depression was thought to be a complication of epilepsy.

“People with a history of depression have a 3 to 7 times higher risk of developing epilepsy,” said Dr. Andres Kanner, a specialist on epilepsy at Rush University Medical Center in Chicago. “This kind of information is forcing us to take a second look at the interaction between depression and epilepsy.”

Common pathways between depression and epilepsy might account for recent data suggesting that patients with a psychiatric history may not respond as well to medication or surgery for treatment of their seizures, he said.

Dr. Kanner and his colleagues recently studied 90 patients whose seizures failed to respond to anti-epileptic medication and underwent brain surgery to remove tissue that was the focus of the seizures.

Patients with a lifetime history of depression were less likely to become seizure-free, the researchers found. Kanner said that suggests depression could be a biological marker for a more severe form of epilepsy.

“Patients with epilepsy usually respond well to antidepression medication and with lower doses,” he said.

“There is a lot of misperception that if you use an anti-depressant, it will worsen the seizures. That is not really so.”

Kanner said a class of drugs called selective serotonin reuptake inhibitors, have proved safe in patients with epilepsy.

They include:

Zoloft
Paxil
Prozac

The incidence and prevalence of depression in the epilepsy population is difficult to establish, mainly because of the under-reporting and under diagnosis of depressive symptoms. Additionally, the diverse methodologies and sample populations used across studies yield drastically different study conclusions.

However, depression may have a major impact on the quality of life of patients with epilepsy, sometimes even more than the seizures.

Valproate and Lamictal tend to stabilize mood, for instance, while Lyrica has anti-anxiety effects, reported Dr. Kanner.

“These drugs definitely are being used more and more by psychiatrists to treat patients with a variety of psychiatric disorders, but primarily mood and anxiety disorders,” he noted.

What Are the Types of Antidepressants?

There are several types of antidepressants that improve depression. The major types of antidepressants include:

Selective serotonin reuptake inhibitors (SSRIs). SSRIs work by altering the amount of a chemical in the brain called serotonin.

Examples:

Celexa 
Brintellix
Lexapro
Paxil 
Prozac 
Zoloft 
Viibryd 

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another form of antidepressant medicine that treat depression by increasing availability of the brain chemicals serotonin and norepinephrine.

Examples:

Cymbalta 
Effexor 
Fetzima 
Ixel, Savella
Pristiq 
Tofenacin 

Tricyclic antidepressants (TCAs) primarily affect the levels of two chemical messengers in the brain, norepinephrine and serotonin.

Although these drugs are effective in treating depression, they can have more side-effects than other drugs. So, they typically aren’t the first drugs prescribed.

Examples include:

Elavil 
Desipramine 
Doxepin 
Imipramine 
Nortriptyline
Protriptyline
Surmontil 

Monoamine oxidase inhibitors (MAOIs).

MAOIs are most effective in people with depression who do not respond to other treatments.

They are also effective for treating other mental illnesses. Substances in certain foods like cheese and aged meats, and certain medications (like decongestants or some cough syrups) can interact dangerously with an MAOI.

Marplan 
Nardil 
Parnate 
Transdermal Selegiline (the EMSAM skin patch)

Although MAOIs work well, they’re not prescribed very often because of the risk of dangerous reactions. They can cause serious interactions with other medications and certain foods. Foods that can negatively react with the MAOIs include aged cheese and aged meats.

People taking this drug must adhere to strict dietary restrictions. For this reason these antidepressants also aren’t usually the first drugs prescribed.

Other medicines may be prescribed in addition to antidepressants, particularly in treatment resistant depression.

Here are examples of medicines that may be used to augment as an add-on to antidepressant treatment:

Anti-psychotic medications like Abilify and Seroquel can be used as an add-on to antidepressant treatment. Symbyax, a combination of the anti-psychotic drug Zyprexa and an SSRI (Fluoxetine), are approved for treatment-resistant depression.

Other medications:

Buspropion may be less likely to cause sexual side-effects than other antidepressants.
Remeron is usually taken at bedtime. Side-effects are usually mild and include sleepiness, weight gain, elevated triglycerides, and dizziness.
Trazodone is usually taken with food to reduce chance for stomach upset. Other side-effects include drowsiness, dizziness, constipation, dry mouth, and blurry vision.

Wellbutrin, is associated with a higher risk of seizures and should not be used in people with epilepsy.

Benzodiazepines are very effective in the short-term treatment of anxiety and insomnia, but they should be avoided if possible, because they are among the most habit-forming (addictive) drugs legally available. They include:

Ativan 
Frisium 
Halcion 
Klonopin 
Librium 
Prosom 
Tranxene 
Valium 
Xanax 

These drugs also may temporarily reduce seizure frequency and intensity but, after someone takes the same dose for a period of weeks, the effect on anxiety, insomnia, and seizure control diminishes.

As the original anxiety or seizures return, there is a strong tendency for the patient and doctor to increase the dose, which again briefly reduces troublesome symptoms.

This cycle leads to a buildup of the dose to levels that can cause memory impairment, depression, tiredness, and other problems.

If the dose is then reduced, the real trouble begins: anxiety, insomnia, and seizures become more severe.

Finally, researchers are investigating new drugs to treat seizures and other conditions which may be useful for certain anxiety disorders, such as social anxiety disorder and general anxiety disorder.

Their exact role in the treatment of epilepsy however, is not clear.

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Resources:
http://www.ncbi.nlm.nih.gov/pubmed/18408525
http://www.cnn.com/2010/HEALTH/04/13/depression.drugs.suicide.risk/
http://www.livestrong.com/article/162514-anti-seizure-medications-used-for-bipolar-disorder-treatment/
http://www.webmd.com/depression/guide/optimizing-depression-medicines?page=2#2
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002598/
http://epilepsy.med.nyu.edu/living-with-epilepsy/related-disorders/anxiety-and-epilpsy#sthash.OVPzmssP.dpbs
http://www.uspharmacist.com/content/d/feature/i/2181/c/37593/
http://www.anxietysecrets.com/loungeFrame-11.htm#Anticonvulsants
http://www.sciencedaily.com/releases/2005/02/050223144959.htm


18 Comments »

  1. Valporate stabilizes mood? It depends on the individual’s body.

    Like

    Comment by TT — April 24, 2016 @ 4:27 PM

  2. Reblogged this on 40+/Single/Clueless and commented:
    I don’t agree certain aspects of this article, but there is a lot of food for thought in here. #epilepsylivesmatter 🙂 #iam #oneintwentysix

    Like

    Comment by TT — April 24, 2016 @ 4:30 PM

  3. Thank you for this informative post!

    Like

    Comment by Robert Matthew Goldstein — April 24, 2016 @ 5:13 PM

  4. I agree TT. EVERYTHING depends upon someone’s individual chemistry.

    Like

    Comment by Phylis Feiner Johnson — April 24, 2016 @ 5:38 PM

  5. I was born with the birth defect Spina Bifida and an accompanying condition called Hydrocephalus with countless neurosurgeries in my lifetime. I had the “average” depression during high school (senior class of 1985); then had “clinical” during college (graduating June of 1990). Epileptic grand mal seizure during neurosurgery for Hydrocephalus that September.

    Like

    Comment by Peter Rutt — April 24, 2016 @ 6:13 PM

  6. Peter, it sounds like you’ve been down a rough road. How did you deal with it?

    Like

    Comment by Phylis Feiner Johnson — April 24, 2016 @ 7:12 PM

  7. I have had depression since I was young and anxiety as well, and didn’t know until l was 27. Now I take zolof for my depression, and Ativan for my anxiety.

    Like

    Comment by michele metzger — April 25, 2016 @ 12:05 AM

    • Michele, I’m glad you identified it and are taking care of your depression and anxiety.

      (Don’t the two of them inevitably seem to go hand-in-hand?)

      Like

      Comment by Phylis Feiner Johnson — April 25, 2016 @ 9:57 AM

  8. you,re right about tradosone it help a lot I have bad anxiety atack been takin it for about 6 or 7 mo. and now all I want to do is sleep very weak and forgetfull so bad and my seizure are weird so I don’t know what to do I guess my only thing to do is talk to neurologist but he loves to prescribe high price meds am taking one right now man its more than my ssi but it works its called aption

    Like

    Comment by jeannine lavigne — April 25, 2016 @ 9:51 AM

  9. There’s a generic for aptiom called eslicarbazepine acetate.

    I would suggest you talk to him about the generic which would cost you much less.

    This link may help:

    DEEPLY DISCOUNTED DRUGS WITHOUT INSURANCE

    https://epilepsytalk.com/2010/03/18/deeply-discounted-drugs-without-insurance/

    Like

    Comment by Phylis Feiner Johnson — April 25, 2016 @ 10:14 AM

  10. Good God, for anyone to recommend Benzodiazepines for insomnia is crazy. Benzodiazepines should only be taken if absolutely necessary. Not as some sort of sleep aid. Worst possible use, in my opinion. It’s such a powerful drug that can cause addition and if you are addicted, your whole life can be majorly effected. And if you are lucky to come off of it the withdrawal pains are incredibly, one needs outside intervention to come of these types of drugs. Otherwise the addiction will continue. I know, I knew of a lady friend who was addicted and her family life almost deteriorated, but luckily she had good friends that help her mentally get outside help. Her withdrawal was like hell, consisted of seizures and shaking for quite some time. And this person was not an epileptic.

    I take ativan as an emergency pill for when i have an Aura that a seizure is about to come on. I take 2 x 2gm pills, and the effects of that will last for 3 days with me. Talk about depression, those 3 days for me are filled with depression and negate mood. I have to take it, but my seizures happen now once every 2 months, so I’m glad i don’t have to take it often. Plus the taste of it is simply disgusting.

    Like

    Comment by Zolt — April 25, 2016 @ 7:00 PM

  11. Zolt, I agree with you about addiction. But there are some people who have more addictive personalities than others.

    For example, I’ve been “on” Xanax for 5 years and a bottle lasts me about 6 months.

    That’s not to negate the agony and addiction of your friend, which must have been a true horror.

    Everyone’s chemistry is different, as are their bodies.

    But to blindly diagnose someone with benzos is pure folly.

    Hey, how about starting with Melatonin? 🙂 🙂 🙂

    Like

    Comment by Phylis Feiner Johnson — April 25, 2016 @ 7:11 PM

  12. Some epilepsy medications can cause medically induced clinical depression. Which can only be treated with a pet when antidepressants counter react the nerve depressants given for epilepsy.

    Like

    Comment by Jeanine — April 27, 2016 @ 3:25 AM

  13. Great point. I’d rather have a dog than meds any day. And no side-effects. (Except for love!)

    Like

    Comment by Phylis Feiner Johnson — April 27, 2016 @ 7:16 AM

  14. Please include me
    My daughter has right TLE w severe depression
    Always searching for answers
    Thanks

    Like

    Comment by Nanette Katz — July 4, 2016 @ 12:56 PM

  15. Feel free to join us, Nanette. Simply go to the bottom of the right column and click on “Follow”.

    That way you’ll automatically get an email each time a new article is published.

    Like

    Comment by Phylis Feiner Johnson — July 4, 2016 @ 2:18 PM

  16. I have been having seizures since i was 12 years. It has been very embarrasing having seizures and living with epilepsy for that long. I have taken different medications, gone for different therapy sessions and took different surgeries. I went for EEG and MRI scan and the doctor said my seizures were very serious and almost incurable. So i searched online for natural herbal remedy and got in contact with dr rick, i explained my situation to him and forwarded my medical report to me. He sent me cannabis oil and bacopamine and instructed me to be on a ketogenic diet. After 4 to 5 months of taking the medication and constant eating of oily fish surprisingly my seizures started reducing until it completely stopped. For the past 3 months i have not had any seizures, thanks to dr rick. You can contact dr rick by email on rickepilepsytreatment@gmail.com

    Like

    Comment by Samantha — September 5, 2016 @ 4:17 AM

  17. Samantha, that’s a fantastic story. I’m so proud of you (as you must be). Congratulations and thanks for the link.

    Like

    Comment by Phylis Feiner Johnson — September 5, 2016 @ 9:49 AM


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    About the author

    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I also had epilepsy for decades. My mission is advocacy; to increase education, awareness and funding for epilepsy research. Together, we can make a huge difference. If not changing the world, at least helping each other, with wisdom, compassion and sharing.

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