Meeting abstract

https://doi.org/10.24869/spsih.2026.336

Initiation of Psychopharmacotherapy in a Patient With Epilepsy – A Case Report

Ena Paparić ; Insula County Hospital for Psychiatry and Rehabilitation, Kampor 224, 51280 Rab, Croatia *
Sandra Blažević Zelić ; Clinical Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia; Faculty of Medicine in Rijeka, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
Ilijana Stanivuk ; Clinical Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia; Faculty of Medicine in Rijeka, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
Aristea Pavešić Radonja ; Clinical Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia; Faculty of Medicine in Rijeka, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia

* Corresponding author.

Abstract

Introduction: Individuals with epilepsy have a significantly
higher prevalence of mental disorders
compared to the general population. Psychiatric
comorbidity is present in more than one-third of
people with epilepsy, markedly impairs quality of
life, increases suicide risk, and complicates adherence
and optimal dosing of antiepileptic therapy.
The bidirectional relationship between epilepsy
and mental disorders, together with the potential
psychotropic adverse effects of antiepileptic
drugs, requires a multidisciplinary treatment
approach. Case report: We present a female patient
in her early thirties who has been treated
for epilepsy for 11 years. Despite high-dose levetiracetam
therapy, she still experiences up to six epileptic seizures per year. She was referred for
psychiatric evaluation due to anxiety–depressive
symptoms, with the need to take into account the
known psychotropic potential of levetiracetam,
which in some patients can induce or worsen depression,
anxiety, and affective lability. The clinical
picture is dominated by low mood, anxiety,
affective lability, social withdrawal, and occasional
compulsions and intrusive thoughts. The initial
recommendation was to introduce vortioxetine
and quetiapine; however, the treating neurologist
rejected this therapy due to concern about its impact
on the epileptogenic threshold. The patient
was then referred to a clinical pharmacologist.
Discussion: This case raises several key questions
that will be addressed in more detail in the paper:
How safe are SSRI antidepressants actually
in people with epilepsy, and is there a possible
protective effect via serotonergic mechanisms?
What is the true epileptogenic potential of quetiapine
compared with other antipsychotics? To
what extent do psychiatric side effects of antiepileptic
drugs contribute to the clinical picture,
and should a change of antiepileptic medication
be considered? How can an effective model of
multidisciplinary collaboration between psychiatrist,
neurologist, and clinical pharmacologist
be established in everyday practice? Conclusion:
The high prevalence of psychiatric comorbidities
in epilepsy and the complexity of pharmacokinetic
interactions require a systematic, multidisciplinary
approach. The development of clear
interdisciplinary guidelines would allow for safer
and more effective treatment of mental disorders
without compromising seizure control.

Keywords

depression; epilepsy; epileptogenic threshold; antiepileptic drugs

Hrčak ID:

353108

URI

https://hrcak.srce.hr/353108

Publication date:

15.6.2026.

Article data in other languages: croatian

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