Psychotropic effects of antiepileptic drugs

Abstract

It is well known that antiepileptic agents are psychoactive compounds that not only act to control seizures but also produce changes in cognition, mood, and behavior. This was first recognized with the early use of phenobarbital and the production of hyperactivity, aggression, and declining school performance in epileptic children. The current first-line antiepileptic drugs (AEDs), carbamazepine, valproate, and phenytoin, as well as the adjunctive and newer agents clonazepam, lamotrigine, and gabapentin all have varying psychotropic effects. These effects however are not always deleterious and have been so positive in selective disorders that the AEDs are now commonly used as second-line agents in primary psychiatric disorders. These agents can be used clinically to improve the functioning of patients with behavioral dyscontrol, panic, anxiety disorders, mania, and depression. Carbamazepine reportedly shows positive effects as a mood normalizer and in hypermanic episodes and valproate in bipolar and schizoaffective disorders. The benzodiazepines have long been recognized as potent anxiolytics with approved usage in panic disorders. The newer agents, gabapentin and lamotrigine, have also been noted to affect mood and produce some anxiolytic effect. As knowledge of these positive pharmacologic effects is gained, the treatment of epileptic patients with comorbid anxiety and mood disorders can be better managed.