Can escitalopram (citalopram's s-enantiomer) cause seizures?

From the Guidelines

Yes, it is possible to have seizures while taking escitalopram, as seizures have been observed in the context of SSRI use, including escitalopram. According to the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1, SSRIs, including escitalopram, should be used cautiously in patients with a history of a seizure disorder. The guideline highlights that potentially serious adverse effects of SSRIs include seizures, among other conditions like suicidal thinking and behavior, behavioral activation/agitation, and serotonin syndrome.

Key Considerations

• The risk of seizures with escitalopram is considered rare but may be increased in certain situations, such as at high doses, in individuals with a history of seizure disorders, or when combined with other medications that can lower the seizure threshold.
• The mechanism behind the seizure risk with SSRIs like escitalopram involves the effect of these medications on brain neurotransmitters, particularly serotonin, which can influence neuronal excitability in susceptible individuals.
• It is crucial for patients taking escitalopram to be aware of the signs of seizures, such as convulsions, loss of consciousness, or uncontrollable muscle movements, and to seek immediate medical attention if they experience any of these symptoms.
• Patients should never stop taking escitalopram suddenly, as this can trigger withdrawal symptoms, including seizures; any dose reduction should be gradual and under medical supervision.

Recommendations for Clinical Practice

• Clinicians should carefully evaluate the risk-benefit ratio when prescribing escitalopram, especially in patients with a history of seizures or epilepsy.
• Close monitoring is recommended, particularly in the initial phases of treatment and after dosage adjustments, for signs of seizures or other serious adverse effects.
• Patient education is key, ensuring that individuals taking escitalopram are aware of the potential for seizures and know how to respond if symptoms occur.
• The importance of gradual dose reduction under medical supervision if escitalopram needs to be discontinued should be emphasized to minimize the risk of withdrawal symptoms, including seizures.

From the FDA Drug Label

Although anticonvulsant effects of racemic citalopram have been observed in animal studies, Escitalopram has not been systematically evaluated in patients with a seizure disorder. These patients were excluded from clinical studies during the product's premarketing testing In clinical trials of Escitalopram, cases of convulsion have been reported in association with Escitalopram treatment. The following have been reported with Escitalopram tablet overdosage: • Seizures, which may be delayed, and altered mental status including coma. Signs and symptoms associated with more severe and/or acute cases have included hallucination, syncope, seizure, coma, respiratory arrest, and death.

Yes, it is possible to have seizures on escitalopram, as reported in clinical trials and in cases of overdosage 2, 2, 2.

• Seizures have been reported in association with escitalopram treatment.
• Patients with a history of seizure disorder should be introduced to escitalopram with care.
• Seizures may occur as a result of serotonin syndrome, which can be caused by escitalopram, particularly when used with other serotonergic agents.

From the Research

Seizure Risk with Escitalopram

• Escitalopram, an SSRI, has been studied for its potential to cause seizures, particularly in comparison to its racemic counterpart, citalopram 3.
• A study comparing escitalopram and citalopram in overdose cases found that escitalopram causes fewer seizures than citalopram at comparable doses of the S-enantiomer, with 1.6% of escitalopram cases experiencing a single seizure versus 13.5% of citalopram cases 3.
• However, another study ranked the seizure risk of popular antidepressants and found that escitalopram has a higher risk of new-onset seizures in the elderly compared to some other antidepressants, with an adjusted odds ratio of 1.79 4.
• In patients with epilepsy, SSRIs like escitalopram may not worsen seizure frequency and may even be associated with a possible decrease in seizure frequency in some cases 5.
• A review of antidepressants in epilepsy suggests that SSRIs, including escitalopram, can be used in patients with epilepsy, but with caution and consideration of the individual's seizure risk 6.
• A systematic review of antidepressants for people with epilepsy and depression found that existing evidence on the effectiveness of antidepressants, including escitalopram, is limited, but suggests that SSRIs may not increase the risk of seizures 7.

Key Findings

• Escitalopram may cause fewer seizures than citalopram in overdose cases 3.
• Escitalopram has a higher risk of new-onset seizures in the elderly compared to some other antidepressants 4.
• SSRIs like escitalopram may not worsen seizure frequency in patients with epilepsy and may even decrease seizure frequency in some cases 5.
• Caution is advised when using escitalopram in patients with epilepsy, considering individual seizure risk 6.
• Existing evidence on the effectiveness of escitalopram in treating depressive symptoms in people with epilepsy is limited 7.