Seizures can be a serious adverse effect of antidepressant medications. Antidepressant medications induce seizures by lowering the seizure threshold. Tricyclic antidepressants (TCAs) and bupropion (Wellbutrin) are the antidepressants most associated with seizures. TCAs, which includes imipramine (Tofranil), induce seizures at a rate of 0.3% to 0.6% at effective doses (Rosenstein et al., 1993). Bupropion induces seizures at a rate of up to 0.5% at doses at or below 450mg daily (Davidson, 1989).
Selective Serotonin Reuptake Inhibitors (SSRIs), which include fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) can also induce seizures, but to a lesser degree. The rate of seizures with SSRIs is approximately 0.2% (Duncan and Taylor, 1995).
There are predisposing factors which increase the risk of drug-related seizures, which include having multiple medications prescribed at the same time, sedative or alcohol withdrawal, and a history of previous seizures (Rosenstein et al., 1993).
For patients with epilepsy and for patients with predisposing factors to having drug-related seizures, it is not advisable to take TCAs and bupropion as antidepressants. Instead, SSRIs are recommended for those who need to take an antidepressant, and who also have epilepsy or predisposing factors to having drug-related seizures.
Because of the potential for serious adverse effects of antidepressant medications, it is advisable that antidepressants only be prescribed for serious cases of anxiety and depression. Mild and moderate cases of anxiety and depression can be treated without prescription antidepressant medications. Other more benign and safer options include cognitive behavioral therapy (CBT), self-help interventions, yoga, conscious breathing, progressive muscle relaxation, and natural supplements, just to name a few. Most cases of anxiety and depression do not need an antidepressant medication as treatment, given the serious adverse effects that can occur, such as seizures.