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Sertraline and fluoxetine: safe treatments for children and adolescents with epilepsy and depression.
Epilepsy Behav. 2007 May; 10(3):417-25.EB

Abstract

OBJECTIVE

Depression is frequent, underdiagnosed, and untreated in people with epilepsy. The lack of treatment is partially explained by the concerns over the proconvulsive effects of psychoactive drugs. There are few studies on the effects of selective serotonin reuptake inhibitors (SSRIs) in adults with epilepsy and none in children. The main purpose of the present study was to analyze the impact of SSRIs on the severity and frequency of seizures in children and adolescents with epilepsy and major depressive disorders. In addition, we also evaluated the efficacy of SSRIs in the treatment of depressive symptoms and side effects other than seizure aggravation.

METHODS

Monthly frequency of seizures was recorded in the 3-6 months preceding the introduction of SSRIs. According to the criteria proposed by A.M. Kanner, A.M. Kozak and M. Frey (Epilepsy Behav 2000;1:100-5), a positive correlation between introduction of SSRIs and seizure worsening should be considered in the following circumstances: (1) occurrence of de novo generalized tonic-clonic (GTC) seizures; (2) recurrence of GTC seizures following a period of at least 1 year without such episodes; and (3) increase in monthly seizure frequency compared with that reported before introduction of SSRIs. Seizure worsening was considered as probably caused by an SSRI when the increase in monthly frequency occurred in a period up to 3 months after the beginning of SSRI use.

RESULTS

Thirty-six children with epilepsy had a depressive disorder. Seizures worsened in two patients. Among this group of patients with depression, all had an improvement in their depressive symptoms. One patient taking fluoxetine had a facial rash and one patient taking sertraline had gastrointestinal disorders. These conditions improved, with total remission, when fluoxetine was replaced with sertraline and vice versa.

CONCLUSION

In this sample of children and adolescents with epilepsy and depressive disorders, we observed that SSRIs are a good therapeutic option, considering their efficacy in remission of depressive symptoms, their few adverse effects, and their maintenance of satisfactory seizure control. Treatment of depression should be considered relevant in the treatment of patients with epilepsy.

Authors+Show Affiliations

Laboratory of Clinical Neurophysiology, University of São Paulo, São Paulo, Brazil. sigridethome@hotmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

17306625

Citation

Thomé-Souza, M S., et al. "Sertraline and Fluoxetine: Safe Treatments for Children and Adolescents With Epilepsy and Depression." Epilepsy & Behavior : E&B, vol. 10, no. 3, 2007, pp. 417-25.
Thomé-Souza MS, Kuczynski E, Valente KD. Sertraline and fluoxetine: safe treatments for children and adolescents with epilepsy and depression. Epilepsy Behav. 2007;10(3):417-25.
Thomé-Souza, M. S., Kuczynski, E., & Valente, K. D. (2007). Sertraline and fluoxetine: safe treatments for children and adolescents with epilepsy and depression. Epilepsy & Behavior : E&B, 10(3), 417-25.
Thomé-Souza MS, Kuczynski E, Valente KD. Sertraline and Fluoxetine: Safe Treatments for Children and Adolescents With Epilepsy and Depression. Epilepsy Behav. 2007;10(3):417-25. PubMed PMID: 17306625.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sertraline and fluoxetine: safe treatments for children and adolescents with epilepsy and depression. AU - Thomé-Souza,M S, AU - Kuczynski,E, AU - Valente,K D, Y1 - 2007/02/15/ PY - 2006/07/19/received PY - 2006/12/26/revised PY - 2007/01/14/accepted PY - 2007/2/20/pubmed PY - 2007/7/19/medline PY - 2007/2/20/entrez SP - 417 EP - 25 JF - Epilepsy & behavior : E&B JO - Epilepsy Behav VL - 10 IS - 3 N2 - OBJECTIVE: Depression is frequent, underdiagnosed, and untreated in people with epilepsy. The lack of treatment is partially explained by the concerns over the proconvulsive effects of psychoactive drugs. There are few studies on the effects of selective serotonin reuptake inhibitors (SSRIs) in adults with epilepsy and none in children. The main purpose of the present study was to analyze the impact of SSRIs on the severity and frequency of seizures in children and adolescents with epilepsy and major depressive disorders. In addition, we also evaluated the efficacy of SSRIs in the treatment of depressive symptoms and side effects other than seizure aggravation. METHODS: Monthly frequency of seizures was recorded in the 3-6 months preceding the introduction of SSRIs. According to the criteria proposed by A.M. Kanner, A.M. Kozak and M. Frey (Epilepsy Behav 2000;1:100-5), a positive correlation between introduction of SSRIs and seizure worsening should be considered in the following circumstances: (1) occurrence of de novo generalized tonic-clonic (GTC) seizures; (2) recurrence of GTC seizures following a period of at least 1 year without such episodes; and (3) increase in monthly seizure frequency compared with that reported before introduction of SSRIs. Seizure worsening was considered as probably caused by an SSRI when the increase in monthly frequency occurred in a period up to 3 months after the beginning of SSRI use. RESULTS: Thirty-six children with epilepsy had a depressive disorder. Seizures worsened in two patients. Among this group of patients with depression, all had an improvement in their depressive symptoms. One patient taking fluoxetine had a facial rash and one patient taking sertraline had gastrointestinal disorders. These conditions improved, with total remission, when fluoxetine was replaced with sertraline and vice versa. CONCLUSION: In this sample of children and adolescents with epilepsy and depressive disorders, we observed that SSRIs are a good therapeutic option, considering their efficacy in remission of depressive symptoms, their few adverse effects, and their maintenance of satisfactory seizure control. Treatment of depression should be considered relevant in the treatment of patients with epilepsy. SN - 1525-5050 UR - https://www.unboundmedicine.com/medline/citation/17306625/Sertraline_and_fluoxetine:_safe_treatments_for_children_and_adolescents_with_epilepsy_and_depression_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1525-5050(07)00012-1 DB - PRIME DP - Unbound Medicine ER -