Antidepressant and Double Antidepressant Treatment for the Affective Disorder of Epilepsy
J Clin Psychiatry 1997;58(1):3-11
© Copyright 2015 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
Background: About half of all patients with chronic epilepsy experience an intermittent and polysymptomatic affective disorder; fewer than 10% suffer from interictal psychotic episodes. The affective disorder responds well to treatment with tricyclic antidepressant medication. The interictal psychosis tends to develop among those with severe affective disorder, responds poorly to antipsychotic medication, and has been more difficult to treat.
Method: At the EpiCare Center, Memphis, Tennessee, we have recently begun to treat refractory cases, both nonresponders with affective disorder and those with interictal psychosis, with the combination of a tricyclic antidepressant (TCA) and a serotonin selective reuptake inhibitor (SSRI). The double antidepressant treatment of all previously intractable patients with interictal affective disorder seen over a 20month period at the EpiCare Center is reported here.
Results: The outcome of the novel treatment for the most severe psychiatric disorders of epilepsy has been highly satisfactory: 15 (68%) of 22 previously unresponsive patients with affective disorder were excellent or good responders.
Conclusion: Antidepressants are the psychotropic drugs of choice for the affective disorder of epilepsy and can be effective in combined form (TCA and SSRI) for otherwise intractable patients. The paradoxical therapeutic effects of proconvulsant drugs in epilepsy conform with the hypothesis that the psychiatric complications of chronic epilepsy result from the development of seizuresuppressing mechanisms that can be mitigated by antidepressants.