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Psychiatric side-effects of medications: recent developments

  • Nora Turjanski and Geoffrey G. Lloyd

Medications often induce neuropsychiatric side-effects. This article reviews psychiatric side-effects that are well known and describes those induced by recently developed medications. Therapeutic innovations have been prominent in the treatment of HIV infection, Parkinson's disease and epilepsy and therefore psychiatric side-effects caused by these agents are described in more detail.

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Psychiatric side-effects of medications: recent developments

  • Nora Turjanski and Geoffrey G. Lloyd
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Are antidepressants anticonvulsants?

Faouzi Dib Alam, Specialist Registrar, Royal Peston Hospital, Sharoe Green Lane, Preston, PR2 9HT
30 August 2006

I read with interest this excellent article by Turjanski and Lloyd (APT 2005) on psychiatric side-effects of medications. In particular I was interested in the section under the heading of treatment of psychiatric complications on p. 65.The paper talks about tricyclic antidepressants being proconvulsants, and the need to start antidepressants at small doses to minimise the risk of seizures in patients with depression and co-morbid epilepsy.I recently undertook a review of antidepressants in epilepsy and found data to suggest that some antidepressants can exert anticonvulsant action.

In two separate studies, the use of tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs) by patients with epilepsy more frequently led to reduced seizure frequency than to exacerbation (Ojemann et al,1987; Gross et al, 2000).It had previously been argued that the serotonergic and noradrenergic effects of antidepressant drugs are anticonvulsant, not proconvulsant (Jobe et al, 1984). Following this an unblinded, open-label, add-on trial of fluoxetinewas conducted in 17 patients with complex partial seizures where 6 patients showed complete disappearance of their daily seizures and in the others the seizure frequency was lowered by 30% (Favale et al, 1995). Meanwhile Hovorka et al evaluated 43 epileptic patients on citalopram who suffered from depression and found that their monthly seizure frequency did not worsen (Hovorka et al, 2000).Finally an open, multicentered, uncontrolled study in 45 epilepsy patients with depression who were treated with citalopram, was conducted, and found an overall improvement in seizure frequency in all 39 patients who completed the study (Specchio et al, 2004).

The above data cast some doubts on whether or not antidepressants reduce seizure threshold especially in patients who suffer from epilepsy.

In the end I suppose the question remains to be answered: are antidepressants anticonvulsants or proconvulsants??

Ojemann, L.M., Baugh-Bookman, C., Dudley, D.L., Effect of psychotropic medications on seizure control in patients with epilepsy. Neurology 1987;37:1525–7.

Gross, A., Devinsky, O., Westbrook, L.E., Wharton, A.H., Alper, K. Psychotropic medication use in patients with epilepsy: effect on seizure frequency. J Neuropsychiatry Clin Neurosci 2000;12:458–64.

Jobe,P.C.,Ko, K.H., Dailey, .JW. (1984) Abnormalities in norepinephrine turnover rate in the central nervous system of the genetically epilepsy-prone rat. Brain Res 290:357-360[ISI] [Medline].

Favale, E., Rubino,V., Mainardi, P., Lunardi, G., Albano, C.Anticonvulsant effect of fluoxetine in humans. Neurology.1995 Oct;45 (10):1926

Hovorka, J., Herman, E., Nemcová, I.,Treatment of Interictal Depression with Citalopram in Patients with Epilepsy. Epilepsy & Behavior, Volume 1, Number 6, December 2000, pp. 444-447(4)

Specchio, L.M., et al. Citalopram as treatment of depression in patients with epilepsy. Clin Neuropharmacol. 2004 May-Jun;27(3):133-136.
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