Epileptic Seizures During Treatment with Antidepressants and Neuroleptics

Epileptic seizures are observed during treatment with antidepressants and neuroleptics more frequently than is the case for other neuroactive substances. Evidence from experimental and observational studies is mixed, suggesting an increased incidence of seizures for certain drugs, whilst other drugs such as SSRIs appear to have a protective effect. There is robust evidence for an elevated seizure incidence (up to 4.5% of treated patients) associated with clozapine treatment, but with other neuroleptics the effect is moderate (2-fold). The evaluation of data from FDA approval reports reveals lower standardised incidence rates associated with antidepressants vs. placebo except for clomipramine and bupropione. Psychiatric disorders such as schizophrenia, depression, and obsessive-compulsive disorder are associated with a considerably increased incidence of seizures. Therefore, in clinical practice, taking into account ictogenic properties of substances is required only in patients with a history of seizures.