Antidepressants and seizures: emphasis on newer agents and clinical implications.
Seizures are a known, relatively rare, consequence of antidepressant treatment. Risk estimates vary depending on the study, source of data and patient population, predisposed vs. nonpredisposed. For newer antidepressants (e.g. selective serotonin reuptake inhibitors, bupropion, mirtazepine, etc.), the risk is generally considered to be low (0.0%-0.4%) and not very different from the incidence of first seizure in the general population (0.07%-0.09%). Risk with tricyclic antidepressants at effective therapeutic doses is relatively high (0.4% to 1-2%). Seizure following overdose is a significant and relatively frequent event for some antidepressants. Patients being considered for antidepressant treatment should be screened for predisposition to seizures. Predisposed patients should receive antidepressants cautiously. The seizure potential of antidepressants in patients without a predisposition is low, especially for newer antidepressants. Seizure risk, along with other drug-related considerations, e.g. weight gain, sexual dysfunction and sedation, should be considered when prescribing an antidepressant.
Montgomery
S A
SA
Imperial College of Medicine, University of London, UK. stuart@samontgomery.co.uk
D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects; D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D018765:Dopamine Uptake Inhibitors / Q000009:adverse effects; D006801:Humans; D008996:Monoamine Oxidase Inhibitors / Q000009:adverse effects; D012640:Seizures / Q000139:chemically induced*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
D018759:Adrenergic Uptake Inhibitors; D000317:Adrenergic alpha-Antagonists; D000929:Antidepressive Agents, Tricyclic; D018765:Dopamine Uptake Inhibitors; D008996:Monoamine Oxidase Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors