Slight improvement in mood and irritability after antiepileptic drug withdrawal: a controlled study in patients on monotherapy.
OBJECTIVE
Most antiepileptic drugs (AEDs) are considered to have effects on mood and to be effective in a number of affective disorders. There are, however, conflicting reports in the literature with respect to the psychotropic properties of AEDs. Many of the studies have a number of methodological problems, and much uncertainty still exists regarding the behavioral and mood effects of AEDs. The aim of this study was to assess, in a randomized, double-blind, placebo-controlled study of seizure-free patients with epilepsy, the effect of withdrawal of AEDs in patients on monotherapy on measures of mood and behavior.


METHODS
One hundred fifteen subjects who had been seizure-free >2 years on drug monotherapy went through a randomized, double-blind, placebo-controlled study. Each patient was included for 12 months or until seizure relapse. Behavioral function was assessed with the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) at baseline and 7 months after withdrawal.


RESULTS
Discontinuation of AEDs resulted, to a greater extent than continued treatment, in a slight improvement in symptoms of depression and irritability. Comparable results were achieved in the subgroup taking carbamazepine. For patients with a high degree of depressive and somatic symptoms at baseline, no significant differences in symptoms emerged in the withdrawal group compared with the non-withdrawal group.


CONCLUSIONS
The results suggest that seizure-free patients with epilepsy on monotherapy can obtain a slight improvement in symptoms characteristic of depression and irritability if they discontinue treatment with AEDs. The described changes are limited, and the functional impact is of uncertain significance.
Hessen
Erik
E
Helse Øst Health Services, Akershus University Hospital, 1478 Lorenskog, Norway. erik.hessen@nevropsykologi.no
Lossius
Morten I
MI
Reinvang
Ivar
I
Gjerstad
Leif
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D016022:Case-Control Studies; D004311:Double-Blind Method; D004827:Epilepsy / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D007508:Irritable Mood / Q000187:drug effects*; D008950:MMPI / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000188:drug therapy* / Q000209:etiology; D011605:Psychoses, Substance-Induced / Q000188:drug therapy* / Q000209:etiology; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000209:etiology
D000927:Anticonvulsants