The Use of Sertraline in Patients with Epilepsy: Is It Safe?

Purpose. The purpose of this study was to assess the impact of the selective serotonin-reuptake inhibitor (SSRI) sertraline (SRT) on the severity and frequency of seizures of patients with epilepsy.Methods. We prospectively assessed the seizure frequency of 100 consecutive patients with partial (n = 95) and primary (n = 5) generalized epilepsy during a trial with SRT for the treatment of a depressive (n = 97) or obsessive-compulsive (n = 3) disorder. We compared the monthly seizure frequency recorded while on SRT with those logged during the 3 and 12 months preceding the start of SRT. A definite causality between seizure worsening and SRT was considered in the following circumstances: (1) occurrence of de novo generalized tonic-clonic seizure (GTC); (2) recurrence of a GTC following a period of at least 1 year without this seizure type; and (3) an increase in the monthly seizure frequency beyond the maximal recorded monthly frequency during both 3- and 12-month periods preceding SRT. A probable causality between SRT and seizure worsening was considered in the case of an increase in monthly seizures beyond the maximal frequency recorded during the 3-month, but not the 12-month, period preceding SRT.Results. Six patients (6%) experienced an increase in seizure frequency after starting SRT. One and five patients met criteria for definite and probable causality between SRT and seizure worsening, respectively. Adjustment of antiepileptic drug doses resulted in a return to baseline seizure frequency in the latter five patients; four patients were kept on SRT at the same doses. The SRT dose of these six patients was significantly lower (57.1 +/- 23.8 mg/day vs 111.8 +/- 56.8 mg/day; F = 6.35, P = 0.01) than that of the other 94 patients.Conclusion. SRT can be safely used in the vast majority of patients with epilepsy.