Epilepsy, antidepressants, and the role of nomifensine

The clinical and animal literature on the relationship between antidepressant drugs and the precipitation of seizures or lowering of the seizure threshold is reviewed. All tricyclic antidepressants have the potential to provoke seizures, particularly in patients with a preexisting lowered seizure threshold. A pilot investigation and a double-blind trial comparing the nontricyclic nomifensine with amitriptyline and placebo in epileptic patients are described. Results of these and other studies suggest that nomifensine--almost alone among the antidepressant drugs--has minimal seizure-provoking effects and therefore may be valuable in the management of patients with epilepsy or other neurologic diseases associated with lowered seizure threshold.