Probable levetiracetam-associated depression in the elderly: two case reports

Area of Science:

• Neurology
• Pharmacology
• Geriatrics

Background:

• Levetiracetam, an antiepileptic drug, is known for its unique mechanism and renal excretion.
• Unlike traditional antiepileptics, levetiracetam has not been previously associated with depression in elderly populations.
• Its favorable drug-interaction profile makes it a common choice for epilepsy management.

Observation:

• Two elderly patients with renal impairment developed new-onset depression after initiating levetiracetam.
• Symptoms included depressed mood, weight loss, fatigue, withdrawal, anhedonia, hypersomnolence, and decreased appetite.
• Depressive symptoms significantly improved or resolved after discontinuing levetiracetam.

Findings:

• Levetiracetam was identified as the probable cause of depression in both cases, supported by Naranjo scale scores of 6.
• The temporal relationship between levetiracetam initiation and symptom onset, followed by improvement upon discontinuation, strongly suggests a causal link.
• This study highlights a potential adverse effect of levetiracetam in elderly individuals, particularly those with compromised renal function.

Implications:

• Clinicians should exercise caution when prescribing levetiracetam to elderly patients, especially those with a history of renal impairment.
• Increased monitoring for depressive symptoms is recommended in this patient population.
• Further research is warranted to elucidate the mechanisms underlying levetiracetam-induced depression and to establish clear guidelines for its use in vulnerable elderly patients.