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.
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My adult daughter takes Keppra and Vimpat for epilepsy. She has depression and has been prescribed SSRI anti depressants….how worried should I be ?
SSRIs are safe to take when prescribed and monitored by a psychiatrist.
My 19 year old daughter went on Prozac for her severe anxiety. She started out on 30mg on October 20, 2014. She had her first seizure (ever) on October 31, 2014. We, and her doctor, did not put this together until very recently. The seizures continued until July of 2015, when she was finally diagnosed with epilepsy and put on Keppra. She no longer has seizures due to the Keppra, but she is now going to taper off Prozac and hopefully, she may not need the Keppra anymore either. Although I have no proof of it, I am pretty sure the seizures started because of the Prozac.
Starting on 30mg of fluoxetine (Prozac) is considered a high dose. Fluoxetine is usually started at 10mg daily, then slowly increased every week or 2 weeks by 10mg, until the patient responds at the therapeutic dose, which is between 20mg to 40mg daily. SSRIs such as fluoxetine do have a small risk of inducing seizures, as detailed in this article. Many physicians do not even know that SSRIs can induce seizures. Doctors need to be educated on this risk. Hopefully, your daughter will not have further seizures when tapered from the medications. Thank you for sharing.
I was on 50mg sertraline for a few weeks and after several days after the dr upped it to 50mg I had a seizure. I never had one before and since stopping this medication I haven’t had any since. I was put back on clonazepam but my dr wont refill due to it is a controlled substance.
Thanks for sharing.