Abstracts

RATIONALE: To report paradoxical effects associated with carbamazepine treatment. Carbamazepine is often the first drug of choice for partial onset seizures. It has also been used to treat a variety of other neurological diseases or symptoms. The drug is often used as a mood stabilizer in persons with schizophrenia or affective disorders. Adverse reactions of carbamazepine in the central nervous system include dizziness, drowsiness, fatigue, visual hallucination, confusion and depression with agitation. However these seemingly paradoxical effects of depression and agitation are rarely reported.
METHODS: In this paper, we describe two adults with depression associated with the introduction of carbamazepine using documentations from clinic notes and patients interviews.
RESULTS: The first patient who is a 31-year-old male, presented with a newly diagnosed partial seizure disorder and carbamazepine was started as the initial treatment. The second patient is a 61-year-old female with an established diagnosis of partial seizures. She had been on Phenobarbital with rare breakthrough partial seizures. Carbamazepine was started with concomitant tapering of Phenobarbital. Both patients are married, have children, and they are employed full-time in competitive positions. They do not have any past psychiatric diagnosis. After several months on carbamazepine with serum levels in mid therapeutic range, they experienced feelings of melancholy, were tearful and had mood swings. On several occasions, they reported having suicidal ideation for no apparent reason. When carbamazepine therapy was discontinued, the symptoms improved and eventually returned to their baseline. There is no recurrence of these symptoms after switching to alternative antiepileptic drugs.
CONCLUSIONS: In conclusion, paradoxical effects from carbamazepine therapy should be considered in patients who express depressive symptoms with no apparent causes.