NEW ORLEANS -- Patients with epilepsy who experience more than one seizure a month appear to achieve a reduction in seizure activity when treated with antidepressants, researchers reported here.
In a retrospective study, 26.6% of 45 such patients given an antidepressant in addition to their anti-epileptic regimen achieved a reduction in seizure frequency, according to Ramses Ribot, MD, a resident in neurology at Rush University Medical Center in Chicago.
Action Points
- This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
- This retrospective observational study suggests that the use of SSRIs and SNRIs is safe in patients with epilepsy and may possibly decrease seizure frequency in those with more than one seizure per month.
The 44 patients who had less than one seizure a month were not helped by the addition of antidepressants, Ribot told ľֱ at his poster presentation at the American Academy of Neurology meeting.
"Depression is the most common psychiatric co-morbidity in patients with epilepsy with a lifetime prevalence of 30%," he explained. But because there have been concerns that antidepressants might worsen seizure activity, depression has been undertreated in these patients.
So, he and his colleagues decided to look at the impact taking the antidepressants had on seizure activity.
"There was no increase in seizure frequency among patients with greater than or equal to one seizure per month while on antidepressant treatment," Ribot concluded from his study of 100 consecutive epilepsy patients treated with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) for depression or anxiety disorders.
"We think this study shows that SSRIs and SNRIs are safe in patients with epilepsy," the researchers concluded. "The improvement in patients with more frequent seizure history may support data suggesting these medications could decrease seizure frequency."
"I am not sure we understand how all these anti-epileptic drugs work and we really aren't certain how antidepressants work either," said Allison Brashear, MD, chair of neurology at Wake Forest Baptist Medical Center in Winston-Salem, N.C. "There is a lot of overlap between these drugs with neurotransmitters and the effects they have on the brain. I can anticipate that there possibly is some crossover between those medications on the ways they impact neural systems. Both types of drugs are believed to work on neurotransmitters so there is a likelihood that there is an overlap between them in some patients.
"This would be an area worth pursuing," Brashear, a spokesperson for the American Academy of Neurology, told ľֱ. "Understanding how these medications affect neural systems is very important."
In their exploratory study, Ribot and colleagues analyzed the patients' medical records 6 months prior to the introduction of antidepressant medication and at 3 and 6 months after treatment was initiated. All the patients in the study remained on antidepressant medication for at least 6 months. Due to changes in anti-epileptic medication, 16 of the patients in the study were not evaluated.
That left 84 patients who were stratified on the basis of seizure frequency. Although the 44 who had fewer than one seizure a month did not see a decrease in seizure activity, neither did they experience an increase in seizures.
Disclosures
Ribot had no disclosures.
Brashear disclosed commercial interests with Allergan, Merz Pharma, and Ipsen.
Primary Source
American Academy of Neurology
Source Reference: Ribot R, et al "Do antidepressant medications have antiepileptic properties?" AAN 2012; Abstract P06.099.