epilepsy and psychotropics

[randomdoc1]

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Anyone know of any good references on this topic of managing patients with epilepsy (especially in regards to neuroleptics and SSRIs/SNRIs)? Aside from the obvious such as bupropion and clomipramine carrying higher risk, I have not had too much exposure in treating patients with epilepsy. Saw on my schedule that a patient with epilepsy is coming to me for an intake. I'd like to be able for the future for patients in general to be able to cite statistics and evidence in more depth and such. Thanks!

 

[Merovinge]

Anyone know of any good references on this topic of managing patients with epilepsy (especially in regards to neuroleptics and SSRIs/SNRIs)? Aside from the obvious such as bupropion and clomipramine carrying higher risk, I have not had too much exposure in treating patients with epilepsy. Saw on my schedule that a patient with epilepsy is coming to me for an intake. I'd like to be able for the future for patients in general to be able to cite statistics and evidence in more depth and such. Thanks!

If the epilepsy is well managed on AEDs and it not a particularly severe epilepsy requiring several AEDs to control my general experience has been the reduction in seizure threshold from atypicals or antidepressants is not an issue. I do get concerned about using medications that lower seizure threshold when the patient has uncontrolled epilepsy and this would change my medication management. Since most psychiatric sx can be caused by uncontrolled epilepsy, solving that is top priority if I see such a patient and generally jam an epileptology consultant down their throat after extensive psychoeducation and possibly some MI. Sorry I don't have any great literature off the top of my dropbox.

 

[deleted452516]

Keep in mind that many AEDs can have psychiatric side effects including irritability and low mood.

Also, in my experience, hyponatremia will be more readily blamed on 'psychiatric medications' than on AEDs, so can be helpful to have a baseline sodium level.

 

[randomdoc1]

Thanks guys, that is actually great to know and I don't feel so stupid about not having the most solid statistics off the top of my head. The idea about the baseline sodium is great too. Doing some of my own research of course and I'll also be sure to get a detailed history on baseline seizure frequency and characteristics as well!

 

[singasongofjoy]

Yes to what @purple rain said about irritability. I work with folks with ASD/DD and more than a few of them are on AEDs. Over the years have seen some MAJOR changes in mood/irritability - Keppra seems to stand out the most but maybe just because those were the most drastic cases. Caregivers may not put 2+2 together with changes in mood/behavior and blame the disorder rather than consider the medication side effects, and thus fail to mention these during med appointments (last place I was patients would often have their psychiatry appts right after therapy appointments with psychology in the same clinic- it was fantastic). So especially in folks who can't communicate it well for themselves, consider the possibility that irritability might be more related to meds than their underlying ASD or whatever else.

Question for you med folks - a lot of my ASD kids (and adults) have major issues with brushing their teeth which as you can imagine can be pretty serious by the time they are adults. Curious - are some AEDs better/worse for the teeth than others?