16 - Psychiatric side effects of antiseizure medic

Psychiatric side effects of antiseizure medications

812 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 10 Psychiatric side effects of antiseizure medications Virtually all antiseizure medications are known to have psychotropic effects. These effects can be both helpful and unhelpful. The adverse and beneficial psychiatric side effects of antiseizure medications are summarised in Table 10.4. Cause of symptoms Description Management Para-­ictal episodes ‘forced normalisation’ (psychiatric symptoms emerging as a result of a reduction in seizure frequency) Psychotic or, less commonly, severe affective symptoms following seizure remission in PWE Rapid medication titration schedules, rapid seizure control, previously medication-­resistant epilepsy, and temporal lobe epilepsy may be risk factors.16 A decision should be made on how to proceed with antiseizure medications and psychotropics through a process of shared decision-­making with carers.15 Symptomatic treatment with antipsychotics or antidepressants may be indicated. Iatrogenic psychiatric symptoms Changes in treatments for seizures could result in psychiatric symptoms as a result of: Starting antiseizure medications with known negative psychotropic properties (particularly in those with a psychiatric history). Stopping antiseizure medications with beneficial psychotropic properties (e.g. mood stabilisation). Starting antiseizure medications with enzyme-­inducing properties in people stable on psychotropics. Surgery for epilepsy: de novo postsurgical episodes of depression, anxiety and, rarely, psychosis have been reported. Exacerbation of pre-­existing conditions more common. Symptoms are managed by resolving the underlying cause in the first instance. Consider switching antiseizure medications with known negative psychotropic properties to better tolerated antiseizure medications (see Table 10.4). Antiseizure medications can lower folate levels which may affect mood. Folate levels should be checked and low levels remedied if necessary. If changing antiseizure medications is not suitable, antidepressants can be considered for iatrogenic depressive symptoms.19 Postsurgical neuropsychiatric symptoms may be treated successfully with psychotropics.18 Table 10.3  (Continued ) Table 10.4  Adverse and beneficial psychiatric side effects of antiseizure medications.5,20,21 Antiseizure medication Adverse psychiatric symptoms Psychiatric benefits Barbiturates, primidone Behavioural disturbance/ADHD symptoms, depression, cognitive impairment Anxiolytic, hypnotic   Benzodiazepines Brivaracetam Depression, aggression, rage, suicidality None reported Carbamazepine, eslicarbazepine, oxcarbazepine Insomnia Mood stabilising, anti-­manic