Atypical Antipsychotics and Serotoninergic Antidepressants in Patients with Epilepsy: Pharmacodynamic Considerations

Abstract

Summary:Purpose: To discuss the pharmacodynamic aspects of the administration of atypical antipsychotics (APs) and serotoninergic antidepressants (SSRIs) to patients with epilepsy.Methods: This article represents an overview of all studies concerning the administration of APs and SSRIs to people with epilepsy. In particular, it deals with the relationship between neuroleptics (NLTs), APs, SSRIs, serotonin, and dopamine, with special focus on the possible epileptogenic role of psychoactive drugs.Results: NLTs may induce seizures by blocking D 2 , H 1 , and .1 receptors, or by sexual hormone activation or a pharmacologic kindling mechanism. The difference among APs in their ability to induce seizures is related mainly to the percentage of D 2 -receptor occupancy and possibly also to their action on neurosteroids. Seizures occur at SSRIs therapeutic doses, with a 0.1-4% incidence. Coversely, in animal studies fluoxetine was claimed to exert an anticonvulsant action.Conclusions: The study of the pharmacodynamic aspects of the administration of APs and SSRIs to patients with epilepsy can help to evaluate the importance of some mechanisms of action of several psychoactive drugs in relation to their proor anticonvulsant activity.

Previous exposure to (±) 3,4-methylenedioxymethamphetamine produces long-lasting alteration in limbic brain excitability measured by electroencephalogram spectrum analysis, brain metabolism and seizure susceptibility

“…However, in mice, 5HT loss is milder, while a severe DA depletion occurs, as described in detail by the Colado's group (Colado et al, 2001) and shown by other studies (Stone et al, 1987;Logan et al, 1988;Ali et al, 1991;Cadet et al, 1995;Fornai et al, 2001Fornai et al, , 2004b. Both monoamines might modulate seizures (see, for instance, Pasini et al, 1996;Starr, 1996;Heisler et al, 1998;Torta and Monaco, 2002;Giorgi et al, 2003Giorgi et al, , 2004. However, this is unlikely to occur in the present study.…”

Suicide in neurologic illness

“…Main side effects Headache, nausea, vomiting, diarrhea or constipation, dry mouth, insomnia or sedation, abnormal dreams, anxiety or anhedonia, tremor, dizziness, fatigue, impaired concentration, agitation, anorexia or weight gain, rash, decreased libido, and delayed ejaculation and anorgasmia. Special points Seizures occur at SSRIs therapeutic doses, with a 0.1% to 4% incidence[59, Class IIIc]. Although animal studies claimed an anticonvulsant action of fluoxetine, the human literature offers no support for this claim.…”

A Case of Treatment Resistant Depression and Alcohol Abuse in a Person with Mental Retardation: Response to Aripiprazole and Fluvoxamine Therapy upon Consideration of a Bipolar Diathesis after Repetitive Failure to Respond to Multiple Antidepressant Trials

“…This is particularly true for special populations such as people with MR, where the use of AAs remains a debated issue [36]. In fact, MR has been reported to be associated with the development of Extrapyramidal Syndromes (EPSs) even with newer antipsychotics [36], which in turn may significantly differ from each other in terms of pharmacological and tolerability profiles [37]. …”