Epilepsy and Psychiatric Comorbidities: Drug Selection.

Area of Science:

• Neurology
• Psychiatry
• Clinical Pharmacology

Background:

• Epilepsy frequently co-occurs with psychiatric comorbidities, complicating treatment.
• Pharmacological management presents challenges due to potential drug interactions and adverse events.

Purpose of the Study:

• To review the rationalization of antiepileptic drug (AED) treatment in patients with epilepsy and psychiatric comorbidities.
• To discuss the management of common psychiatric disorders including mood and anxiety disorders, psychoses, and ADHD in this population.

Main Methods:

• Literature review focusing on pharmacological strategies for epilepsy and comorbid psychiatric conditions.
• Analysis of recent findings regarding treatment-emergent psychiatric adverse events associated with AEDs.
• Presentation of a pragmatic checklist for clinical guidance.

Main Results:

• Up to 8% of patients with drug-resistant epilepsy may experience treatment-emergent psychiatric adverse events from AEDs.
• Underlying psychiatric history and mesolimbic structure involvement may predispose patients to these events.
• Careful patient history, screening, low starting doses, and slow titration can mitigate AED-related psychiatric issues.

Conclusions:

• Patients should be informed about potential behavioral effects of AEDs; no drug should be excluded without consideration.
• Psychiatric comorbidities require appropriate management with the goal of full remission and recovery.
• Neurologists must be knowledgeable about psychotropic drug side effects to effectively counsel patients and healthcare professionals.