Antiepileptic medication side-effects
- Patients with previous psychiatric history are more likely to discontinue AEDs due to psychiatric side-effects 77
- Patients with low socioeconomic status and recreational drug use also were more likely to develop psychiatric side-effects from levetiracetam 79
- In general, sodium channel blockers are less likely to cause neuropsychiatric side-effects 77
- Specific antiseizure medication effects:
- - Carbamazepine – lower likelihood of psychiatric side-effects
- - Clobazam – can be disinhibiting or agitating
- - Eslicarbazepine – lower likelihood of psychiatric and cognitive side-effects
- - Felbamate
- - Gabapentin – lower likelihood of psychiatric and cognitive side-effects
- - Lacosamide – lower likelihood of cognitive side-effects
- - Lamotrigine – lower likelihood of psychiatric and cognitive side-effects
- - Levetiracetam – higher likelihood of psychiatric (depression, aggression, irritability, anxiety, insomnia; less common – psychosis, mania, suicidal ideation) and cognitive side-effects 79–81
o Oxcarbazepine – lower likelihood of psychiatric side-effects o Perampanel – higher likelihood of psychiatric side-effects (aggression, anger, anxiety), dizziness (most common), and somnolence, fatigue, confusion 80–82 o Phenobarbital – higher likelihood of psychiatric and cognitive side-effects o Pregabalin – lower likelihood of psychiatric side-effects o Primidone – higher likelihood of cognitive side-effects o Rufinamide – lower likelihood of cognitive side-effects o Tiagabine – lower likelihood of cognitive side-effects o Topiramate – higher likelihood of psychiatric (depression, irritability, aggressive behavior, anxiety) and cognitive side-effects (bradyphrenia, expressive language disorder, confusion, disorientation) 80,81 o Valproic acid – lower likelihood of psychiatric side-effects o Vigabatrin – higher likelihood of psychiatric side-effects o Zonisamide – higher likelihood of psychiatric and cognitive side-effects
- Often if aggressive behaviors develop or worsen in the setting of AED initiation or uptitration, often the aggressive behavior can only be stopped by discontinuing the AED (though one may consider downtitrating first and observing) 80
