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Preictal and ictal depression do not usually require treatment with antidepressants, as an improvement in seizure frequency should reduce the occurrence of these forms of depression (Labert & Robertson, 1999). Antidepressant therapy will be usually necessary in patients suffering from interictal depression or comorbid depressive disorders. SSRIs are recommended as first-line treatment (Labert & Robertson, 1999, Kanner and Nieto, 1999; Kanner and Palac, 2000). Citalopram and sertraline can be considered first-line SSRIs because of their minimal pharmacokinetic interactions with antiepileptic drugs (Kanner and Nieto, 1999; Barry et al., 2001).
If depression develops, it should be determined whether the patient takes an antiepileptic drug with a known depression-inducing effect, or if treatment with an antiepileptic drug with mood-stabilizing effects was discontinued. In first case, replacement with an antiepileptic drug with mood-stabilizing effects, such as carbamazepine, valproate, lamotrigine, gabapentin or topiramate can be considered. In the latter case, the discontinued agent should be readministered (Labert & Robertson, 1999, Kanner and Nieto, 1999; Kanner and Palac, 2000). In agitated patients who require treatment with sedative preparations, mirtazapine can be considered a treatment option. In general, dosages should be increased carefully and in small increments. Regular EEG recordings are recommended (Prueter and Norra, 2005).
Ref: -
Barry, J.J., Lembke, A. & Hyunh, N. (2001) Affective disorder sin epilepsy. In: Ettinger, A.B. & Kanner, A.M. (Eds.), Psychiatric issues in epilepsy: a practical guide to diagnosis and treatment, Lippincott Williams and Wilkins: Philadelphia. pp 45 - 71.
Kanner, A.M. & Nieto, J.C. (1999) Depressive disorders in epilepsy. Neurology, 53, 5 (suppl 2), s 26 - s32.
Kanner, A.M. & Palac, S. (2000) Depression in epilepsy: a common but often unrecognised comorbid malady. Epilepsy and Behavior, 1, 37-51.
Labert, M.V. & Robertson, M.M. (1999) Depression in epilepsy: etiology, phenomenology, and treatment. Epilepsia, 40 (suppl 10), s21 - 47.
Prueter, C. & Norra, C. (2005) Mood disorders and their treamtnet in patients with epilepsy. Journal of Neuropsychiatry and Clinical Neurosciences, 17, 1, 20-28. How a Diary Can Double Your Weight Loss
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Evidence on the efficacy and safety of with schizophrenia is limited. Toren et al. (2004) reviewed the literature on use of atypical antipsychotics in children and adolescents with schizophrenia. The major findings were:
Risperidone, and possibly also olanzapine, may be the drugs of choice in children with comorbid tic disorders.
Ziprasidone may be administered as an augmenting agent in children and adolescents with schizophrenia and comorbid anxiety and mood disorders.
Risperidone, olanzapine and clozapine are effective in the treatment of aggression and mania.
In children and adolescents receiving clozapine, olanzapine and quetiapine, particularly those with obesity or a family history of diabetes mellitus, fasting blood glucose and lipid levels must be monitored frequently. Weight gain might be better controlled when the children and their parents are properly informed about this adverse effect and diet is regulated.
Hyperprolactinaemia is another major disadvantage of the atypical antipsychotics, especially risperidone. Hyperprolactinaemia can lead to hypogonadism-induced osteoporosis, galactorrhoea, gynaecomastia, irregular menstruation and sexual dysfunction. Other atypical antipsychotics, namely olanzapine and ziprasidone, have been reported to be prolactin sparing in adults, but may not be completely devoid of hyperprolactinaemic effects in children and adolescents. Thus, prolactin levels should be assessed routinely in young patients treated with atypical antipsychotics. Further, children and adolescents with hyperprolactinaemia-related effects should be switched to a prolactin-sparing agent, such as quetiapine.
The use of typical antipsychotics has been limited to patients who are resistant to atypical antipsychotics, intolerant to their adverse effects, or require injections or depot preparations.
Ref: - Toren, P., Ratner, S., Laor, N. & Weizman, A. (2004) Benefit-risk assessment of atypical antipsychotics in the treatment of schizophrenia and comorbid disorders in children and adolescents. Drug Safety, 27, 14, 1135-1156. Applegate's Breast Removal to Stop Cancer
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