When is it inappropriate to prescribe psychotropic medication?

Psychotropic medication can be of great value in the treatment of people with epilepsy, but there are situations in which it is not appropriate and other strategies are needed. A number of different strategies, usually not involving psychotropic medication, are required for the behavioural disturbance associated with prodromal mood changes, anxiety-provoking auras, focal discharges, frequent absence seizures, adverse reactions to antiepileptic medication or adverse reactions to antiepileptic drug interactions, difficulties arising from uneven cognitive profiles, reactions to the epilepsy, and causes that are not related to the epilepsy. The first step should always be to determine the cause or causes of behavioural disturbance. A systematic approach to the assessment of the behavioural or psychiatric problems, using a structured diagnostic framework of possible causes, provides the basis for correct diagnosis and management. This systematic approach assists the clinician in deciding when other strategies are preferable to the prescription of psychotropic medication.