From the Guidelines
Keppra (levetiracetam) is not recommended as a first-line treatment for mood stabilization due to limited and inconsistent evidence supporting its use for mood disorders. The provided evidence [ 1 ] focuses on the use of antiepileptic medications, including Keppra, in the emergency department setting for patients with seizure disorders, and does not directly address mood stabilization. However, it does mention the loading dose and route of administration for Keppra, which is 1,500 mg oral load, with rapid IV loading safe and well-tolerated in doses up to 60 mg/kg [ 1 ].
When considering Keppra for mood symptoms, it's essential to note that established options like lithium, valproate (Depakote), lamotrigine (Lamictal), or certain atypical antipsychotics have stronger evidence and are generally preferred [ 1 ]. If Keppra is used off-label for mood symptoms, dosing typically ranges from 500-1500 mg twice daily, with gradual titration starting at lower doses to minimize side effects such as irritability, fatigue, dizziness, and behavioral changes.
Some key points to consider when evaluating the use of Keppra for mood stabilization include:
- The medication's mechanism for potential mood effects involves its action on synaptic vesicle protein SV2A, which may influence neurotransmitter release [ 1 ].
- Any consideration of Keppra for mood stabilization should involve thorough discussion of risks, benefits, and alternative options with a healthcare provider.
- Patients with both seizure disorders and mood symptoms may benefit from Keppra, but this should be determined through careful evaluation by a psychiatrist or neurologist [ 1 ].
Overall, while Keppra may have some potential benefits for mood stabilization, the current evidence does not support its use as a first-line treatment, and alternative options should be considered [ 1 ].
From the FDA Drug Label
A total of 37.6% of the levetiracetam-treated patients experienced behavioral symptoms (reported as agitation, anxiety, apathy, depersonalization, depression, emotional lability, hostility, hyperkinesia, nervousness, neurosis, and personality disorder), compared to 18.6% of placebo patients. Non-psychotic mood disorders (reported as depressed mood, depression, and mood swings) occurred in 6.7% of levetiracetam-treated patients compared to 3.3% of placebo patients. Nonpsychotic mood disorders (including anger, apathy, depression, mood altered, mood swings, negativism, and tearfulness) occurred in 12.7% of levetiracetam-treated patients compared to 8.3% of placebo patients.
Keppra (levetiracetam) is not typically used for mood stabilization. In fact, the drug label suggests that levetiracetam may be associated with worsening of mood symptoms, including depression, anxiety, and mood swings, in some patients 2. Therefore, it is not recommended to use Keppra for mood stabilization without careful consideration of the potential risks and benefits.
From the Research
Keppra for Mood Stabilization
- Keppra, also known as levetiracetam, is an antiepileptic drug that has been studied for its potential use in mood stabilization 3, 4, 5.
- A case report found that levetiracetam provided both seizure control and mood-stabilizing benefits in a patient who had developed adverse events with other antiepileptic drugs 3.
- A review of levetiracetam's role in managing neurologic and psychiatric disorders found that it has potential benefits in treating anxiety, panic, stress, mood, and bipolar disorders 4.
- Preliminary clinical evidence suggests that levetiracetam has efficacy in a wide range of bipolar spectrum disorders, including a 31% remission rate in patients with bipolar disorder who received levetiracetam as add-on therapy for 8 weeks 5.
- However, more research is needed to fully understand the effects of levetiracetam on mood stabilization, as most of the current evidence is based on case reports and open-label pilot studies 5.
Comparison with Other Antiepileptic Drugs
- A study comparing the efficacy of levetiracetam, lamotrigine, and sodium valproate in patients with juvenile myoclonic epilepsy found that levetiracetam and sodium valproate had similar efficacy, while lamotrigine had a higher rate of failure in controlling seizures and myoclonic jerks 6.
- Another study found that levetiracetam may have a unique mechanism of action that provides mood-stabilizing benefits, unlike other antiepileptic drugs 3.
- Interactions between antiepileptic and antipsychotic drugs can affect both efficacy and toxicity, and levetiracetam may have a more favorable profile in this regard compared to other antiepileptic drugs 7.