How much does Wellbutrin raise the risk of seizure in patients with a history of seizures?

[SpongeBob DoctorPants]

I have a patient who could potentially benefit from Wellbutrin, based on a very good response by her twin sister, and parents are hopeful that she can take it, too. However, she has a history of seizures, gets maybe one per year, and does not take any AEDs. If I were to start her on Wellbutrin, what might be expected in terms of her seizure frequency?

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[Thama]

There isn't really good data to answer that question, and some of the epileptologists I know will say that most medications that supposedly lower the seizure threshold are mostly based in mythology. Bupropion only convincingly lowers the seizure threshold at rather high doses (~3% risk in patients without known epilepsy), while the data at low doses is pretty shaky. That said, if there are reasonable alternatives for treating her, and her seizure frequency were to go up and she were to be adversely affected, you may be exposing yourself to liability due to the reported adverse effect. It's also quite odd that someone who has epilepsy with seizures approximately yearly wouldn't be on an AED at all.

 

[SpongeBob DoctorPants]

Thank you for your response. Unfortunately antidepressant options for this patient are limited, due to adverse effects with various other medications. I was also considering a low dose of levothyroxine to help with her mood, but I read that this can also induce seizures in some patients. What is the risk with levothyroxine? I don't recall being taught to screen for seizures when prescribing it, but now I'm wondering if I should.

 

[Thama]

Neither have I, though I've never prescribed synthroid in someone who wasn't actually hypothyroid so I have no idea if there is a risk associated with making someone artificially mildly hyperthyroid (nor have I ever heard of that practice being kosher). Thyrotoxicosis can present with seizures but I'm obviously guessing you aren't going to OD your patient.