Psychopharmacology Tips

Preictal and ictal depression do not usually require treatment with antidepressants, as an improvement in seizure frequency should reduce the occurrence of these forms of depression (Labert & Robertson, 1999). Antidepressant therapy will be usually necessary in patients suffering from interictal depression or comorbid depressive disorders. SSRIs are recommended as first-line treatment (Labert & Robertson, 1999, Kanner and Nieto, 1999; Kanner and Palac, 2000). Citalopram and sertraline can be considered first-line SSRIs because of their minimal pharmacokinetic interactions with antiepileptic drugs (Kanner and Nieto, 1999; Barry et al., 2001).

If depression develops, it should be determined whether the patient takes an antiepileptic drug with a known depression-inducing effect, or if treatment with an antiepileptic drug with mood-stabilizing effects was discontinued. In first case, replacement with an antiepileptic drug with mood-stabilizing effects, such as carbamazepine, valproate, lamotrigine, gabapentin or topiramate can be considered. In the latter case, the discontinued agent should be readministered (Labert & Robertson, 1999, Kanner and Nieto, 1999; Kanner and Palac, 2000). In agitated patients who require treatment with sedative preparations, mirtazapine can be considered a treatment option. In general, dosages should be increased carefully and in small increments. Regular EEG recordings are recommended (Prueter and Norra, 2005).

Ref: -

Barry, J.J., Lembke, A. & Hyunh, N. (2001) Affective disorder sin epilepsy. In: Ettinger, A.B. & Kanner, A.M. (Eds.), Psychiatric issues in epilepsy: a practical guide to diagnosis and treatment, Lippincott Williams and Wilkins: Philadelphia. pp 45 - 71.

Kanner, A.M. & Nieto, J.C. (1999) Depressive disorders in epilepsy. Neurology, 53, 5 (suppl 2), s 26 - s32.

Kanner, A.M. & Palac, S. (2000) Depression in epilepsy: a common but often unrecognised comorbid malady. Epilepsy and Behavior, 1, 37-51.

Labert, M.V. & Robertson, M.M. (1999) Depression in epilepsy: etiology, phenomenology, and treatment. Epilepsia, 40 (suppl 10), s21 - 47.

Prueter, C. & Norra, C. (2005) Mood disorders and their treamtnet in patients with epilepsy. Journal of Neuropsychiatry and Clinical Neurosciences, 17, 1, 20-28.