ANTIDEPRESSANTS AND SEIZURES - CLINICAL ANECDOTES OVERSHADOW NEUROSCIENCE

Pharmacological treatment of depression in persons with epilepsy has b een an area of controversy because some drugs commonly are perceived s pecifically to induce or exacerbate seizures in patients with seizure disorders. This prevailing misconception is unjustified by scientific studies, yet it continues to prevent afflicted persons from receiving appropriate therapy. The scientific literature shows that tricyclic an tidepressant drugs cause seizures in overdose in both animals and huma ns. In lower doses, these drugs have anticonvulsant activity in humans and animals. Thus, the antidepressant drugs are like several antiepil eptic drugs that can both prevent. and cause seizures. The anticonvuls ant activity of antidepressant drugs has been studied extensively in a nimals and almost certainly stems from their capacity to block norepin ephrine and/or serotonin reuptake. The pharmacodynamic action responsi ble for their convulsant effects has not been well studied but may be due to their local anesthetic, antihistaminic, or antimuscarinic activ ity. The newer, more selective monoamine uptake blockers have very low convulsant liability, and it is suggested that their anticonvulsant a ctivity, which is well documented in animals, be investigated further in humans. If their effects in humans are analogous to those in animal s, these drugs can be used safely in epileptic patients with depressio n, and it is possible that their anticonvulsant activity can be exploi ted for use in the treatment of epilepsy. Copyright (C) 1996 Elsevier Science Inc.