What antidepressants are less likely to exacerbate seizure risk in patients with epilepsy?

From the Guidelines

Patients with epilepsy may be treated with certain antidepressants that have a lower risk of exacerbating seizure activity. Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, citalopram, and escitalopram are generally considered to be safer options, with a recommended starting dose of 25-50mg per day and gradual titration as needed 1. Additionally, venlafaxine may also be considered as an alternative with a relatively lower risk of seizure induction, as it has been used in the treatment of other conditions with variable success 1.

• It is essential to note that bupropion may lower the seizure threshold and should be avoided in patients with epilepsy or used with caution in patients with a history of seizures or with clinical factors that may increase the risk of seizures 1.
• The use of trazodone may also be considered as an alternative, but its efficacy and safety in patients with epilepsy are not well established.
• When prescribing antidepressants to patients with epilepsy, it is crucial to weigh the potential benefits against the risks and to closely monitor the patient's condition, adjusting the treatment plan as needed.
• In general, the choice of antidepressant should be based on the individual patient's needs and medical history, and should be made in consultation with a healthcare professional.

From the Research

Antidepressants and Seizure Risk in Epilepsy

• The risk of antidepressant-associated seizures is generally low, and most antidepressants are not likely to exacerbate seizure risk in patients with epilepsy 2.
• Certain antidepressants, such as amoxapine, bupropion, clomipramine, and maprotiline, are not recommended for patients with epilepsy due to their potential to increase seizure risk 2.
• Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered safe for use in patients with epilepsy, with some studies suggesting they may even lower the risk of triggering seizures 2, 3.
• Specific antidepressants that are considered safe for use in patients with epilepsy include:
  • SSRIs: sertraline, citalopram, paroxetine, fluoxetine, escitalopram, fluvoxamine 2, 3, 4
  • SNRIs: venlafaxine, duloxetine 2, 3
  • Other antidepressants: mirtazapine, reboxetine 2

Factors Influencing Seizure Risk

• The risk of seizures associated with antidepressants is dose-dependent, with higher doses increasing the risk of seizures 5, 6.
• Individual factors, such as a history of epilepsy or brain damage, can also influence the risk of seizures associated with antidepressants 5, 6.
• The use of antiepileptic drugs in combination with antidepressants can also affect the risk of seizures, and careful monitoring and adjustment of medication doses may be necessary to minimize this risk 4.