title: Proconvulsant effects of antidepressants - What is the current evidence?
abstract: Antidepressant drugs may have proconvulsant effects. Psychiatric comorbidity in epilepsy is common. Prescribers might be reluctant to initiate treatment with antidepressants in fear of seizure aggravation. The purpose of this review was to focus upon the current evidence for proconvulsant effects of antidepressants and possible clinical implications. Most antidepressants are regarded as safe and may be used in patients with epilepsy, such as the newer serotonin and/or noradrenaline reuptake inhibitors. Four older drugs should, however, be avoided or used with caution; amoxapine, bupropion, clomipramine and maprotiline. Proconvulsant effects are concentration-related. Optimization of drug treatment includes considerations of pharmacokinetic variability to avoid high serum concentrations of the most proconvulsant antidepressants. The risk of seizures is regarded as small and should, therefore, not hamper the pharmacological treatment of depression in people with epilepsy.
authors.affiliation: Dept. of Life Sciences and Health, Programme for Pharmacy, Faculty of Health Science, Oslo and Akershus University College of Applied Sciences, Oslo, Norway; The National Center for Epilepsy, Sandvika, Oslo University Hospital, Oslo, Norway; Department of Pharmacology, Oslo University Hospital, Oslo, Norway. Electronic address: cecilie.landmark@hioa.no.
authors.forename: Cecilie
authors.initials: C
authors.lastname: Johannessen Landmark
authors.affiliation: The National Center for Epilepsy, Sandvika, Oslo University Hospital, Oslo, Norway.
authors.forename: Oliver
authors.initials: O
authors.lastname: Henning
authors.affiliation: The National Center for Epilepsy, Sandvika, Oslo University Hospital, Oslo, Norway; Department of Pharmacology, Oslo University Hospital, Oslo, Norway.
authors.forename: Svein I
authors.initials: SI
authors.lastname: Johannessen
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy*; D004827:Epilepsy / Q000139:chemically induced* / Q000150:complications; D006801:Humans; D012640:Seizures / Q000139:chemically induced* / Q000150:complications
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressant drugs; Drug safety; Proconvulsant; Seizures