Psychotropic Effects of Antiepileptic Drugs

Abstract

Antiepileptic drugs (AEDs) are psychotropic agents; that is, they act on the mind and can positively or negatively influence behavior. This result is expected, given their mechanisms of action, which are to alter ion channel and neurotransmitter system functions and, thereby, modulate the electrochemical systems that underlie behavior. Behavioral effects (e.g., cognitive and mood) associated with AEDs are complex and can vary dramatically between patients. It is currently not possible to predict which patient with epilepsy will tolerate an AED and which one will develop adverse, as opposed to positive, psychotropic effects.

A young woman with seizures and psychosis

“…The psychopharmacological effects of phenytoin encompasses a broad spectrum ranging from decreased cognition, sedation and psychomotor retardation to antidepressant and antimanic activity and mood stabilisation 6. Awareness of these properties has expectedly led to off-label use of phenytoin in an adjunctive role for a wide variety of psychiatric disorders including acute mania, in combination with haloperidol, and bipolar disorder, post-traumatic stress disorder and intermittent explosive disorder as a single agent 8.…”

“…Awareness of these properties has expectedly led to off-label use of phenytoin in an adjunctive role for a wide variety of psychiatric disorders including acute mania, in combination with haloperidol, and bipolar disorder, post-traumatic stress disorder and intermittent explosive disorder as a single agent 8. These indications are based predominantly on case reports, small open-label series and poorly designed controlled studies, and have not been confirmed by larger adequately powered trials 6. Thus phenytoin is not currently indicated for any psychiatric condition.…”

Letter to the Editor

“…Conversely, seizures could be mistaken as evidence of psychiatric illness (Mirsattari et al 2011). Therapeutically, medication used for seizure control may have psychiatric sequelae (Nadkarni & Devinsky, 2005) and psychiatric medication may interact with anti-epileptic drugs (Johannessen & Landmark 2010) or alter seizure threshold. From a risk-related viewpoint, those with comorbid epilepsy have specific risks to consider including but not limited to areas such as bathing and using electrical equipment (National Institute of Clinical Excellence, 2016).…”

The effect of felbamate on behavioural sensitization to methamphetamine in mice

“…Generally, antiepileptic drugs from this generation invoke psychotropic eff ects. Th ey may exert attention-enhancing and antidepressant eff ects, and cause anxiety, insomnia, and agitation (Nadkarni and Devinsky 2005;Sharma et al 2008). Felbamate was also reported to significantly inhibit the nociception induced by glutamate (Beirith et al 2002).…”