Highlights
- •Depression and anxiety are common co-morbidities in patients with epilepsy, which remain under-recognized and under-treated.
- •This study investigated the impact of SSRIs and SNRIs in the seizure frequency of patients with epilepsy.
- •SSRIs or SNRIs did not appear to worsen seizure frequency.
- •In patients with frequent seizures, SSRIs and SNRIs may be associated with a decrease in seizure frequency.
- •The change in seizure frequency was independent of the improvement in psychiatric symptomatology.
Abstract
Purpose
Depression and anxiety disorders in patients with epilepsy (PWE) remain under-recognized
and under-treated, despite being the most common psychiatric co-morbidities. Selective
serotonin re-uptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors
(SNRIs) are considered first-line treatment for primary depression and anxiety disorders.
We performed this study to investigate if SSRIs and SNRIs could affect the seizure
frequency of PWE and to assess whether such effect is independent of the response
of the mood and anxiety disorders to these drugs.
Methods
This was a retrospective study of 100 consecutive PWE who were started on an SSRI
or SNRI for the treatment of a depressive and/or anxiety disorder. Every patient underwent
a psychiatric evaluation by one of the investigators using a semi-structured interview
who also managed the pharmacologic treatment in all the patients. Patients were excluded
if they had a diagnosis of psychogenic non-epileptic seizures or if they had undergone
epilepsy surgery or the implant of the vagal nerve stimulator six months before and
after the start of the antidepressant therapy. The final analysis was conducted in
84 patients. For each type of seizure, an average and maximal monthly seizure frequency
during the six months preceding and following the start of psychotropic drugs was
extracted from the medical records. We identified the number of patients whose seizure
frequency during treatment with antidepressants: (i) shifted from a <1/month to a ≥1 seizure/month and vice-versa, (ii) increased beyond maximal/monthly baseline frequency,
and (iii) patients who developed de-novo generalized tonic-clonic (GTC) seizures.
Results
None of the patients with a baseline seizure frequency <1 seizure/month went on to have ≥1 seizure/month after initiating treatment with antidepressants, had an increase in
frequency beyond baseline maximal counts or developed de-novo-GTC seizures. Furthermore,
there was no seizure recurrence among patients that had been seizure-free. Among the
patients with a baseline seizure frequency ≥1/month, 27.5% had a reduction in seizure frequency to <1/month, which suggested a positive effect of SSRI/SNRI on seizure frequency (p = 0.001, McNemar test). Among the patients with a baseline seizure frequency ≥1 seizure/month, 48% exhibited a >50% reduction in seizure frequency after the start of treatment with SSRIs or SNRIs.
A therapeutic response to SSRIs and SNRIs was found in 73% of patients. The change
in seizure frequency was independent of the improvement in psychiatric symptomatology.
Conclusion
In this retrospective observational study, SSRIs or SNRIs did not appear to worsen
seizure frequency. Also, in patients with frequent seizures, SSRIs and SNRIs may be
associated with a possible decrease in seizure frequency. Furthermore, these drugs
appear to yield good therapeutic response of psychiatric symptoms independently of
seizure frequency. It is pivotal to replicate these data in prospective, double-blind,
placebo-controlled trials.
Keywords
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Gilliam FG, Black KJ, Carter J, Vahle V, Randall A, Sheline Y, Tsai W-Y, Lustman P: Depression and health outcomes in epilepsy: a randomized trial. Presented at the 61st annual meeting of the American Academy of Neurology: 25 April–02 May 2009; Seattle, Washington, USA.
Article info
Publication history
Published online: April 10, 2017
Accepted:
February 20,
2017
Received in revised form:
February 20,
2017
Received:
January 6,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
