Epilepsy Talk

Antidepressants and epilepsy… | May 22, 2022

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

“People with a history of depression have a 3 to 7 times higher risk of developing epilepsy. This kind of information is forcing us to take a second look at the interaction between depression and epilepsy” said Dr. Andres Kanner, a Professor of Clinical Neurology and Director of the Comprehensive Epilepsy Center of the University of Miami, Miller School of Medicine.

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 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 misconception 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.sciencedaily.com/releases/2005/02/050223144959.htm

http://www.cnn.com/2010/HEALTH/04/13/depression.drugs.suicide.risk/

http://www.webmd.com/depression/guide/optimizing-depression-medicines?page=2#2

http://www.uspharmacist.com/content/d/feature/i/2181/c/37593/

http://www.anxietysecrets.com/loungeFrame-11.htm#Anticonvulsants

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002598/

http://www.ncbi.nlm.nih.gov/pubmed/18408525

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