Abstracts

The purpose of this study was to asses the efficacy and safety of the selective serotonin-reuptake inhibitor (SSRI) paroxetine in depressed and anxious epileptic patients. We evaluated 31 epileptic patients (18 female, 13 male), who suffered from interictal depressive disorder, additionally 22 of these had symptoms of interictal anxiety disorder (generalised anxiety disorder and panic disorder). Before treatment the diagnoses were verified with MINI International Neuropsychiatric Interview. Patients were evaluated using HAMD17 and HAMA scales before paroxetine treatment and after 4 and 8 weeks of treatment. The dose of paroxetine was fixed, 10 mg/day for one week followed by 20 mg/day from week 2. During paroxetine treatment there were only minor changes in antiepileptic therapy, in all patients epilepsy was stabilized. The presence of depressive and anxiety symptoms were not related to epileptic seizures in time. During paroxetine treatment we found HAMD 17 total score to have decreased from 20.5[plusmn]3.7 (range 14-28) pre-treatment to 14.1[plusmn]2.8 (range 9-20) (p[lt]0.001) after 4 weeks and to 9.1[plusmn]2.0 (range 4-13) (p[lt]0.001) after 8 weeks of treatment. During treatment we found in 22 patients with comorbid anxiety disorder a decrease in HAMA total score from 26.0[plusmn]6.6 (range 16-37) pre-treatment to 17.8[plusmn]4.9 (range 10-27) (p[lt]0,001) after 4 weeks and to 10.1[plusmn]2.3 (range 6-16) (p[lt]0.001) after 8 weeks of treatment. The number of responders, related to depressive symptoms, ([gt]50% decrease in HAMD 17) was 6 (19.3%) and 20 (64.5%) patients after 4 and 8 weeks of treatment respectively.
The number of responders, related to anxious symptoms, ([gt]50% decrease of HAMA 17) was after 4 weeks of treatment: 4 patients (19.3%) from those with a positive diagnosis of anxiety disorder (n=22), after 8 weeks of treatment: 17 patients (77.3%). Nausea was the most common adverse event, occurring in 8 patients (25.8%) during the first treatment month, in 2 patients (6.4%) continuing during the second month. Sexual function problems (decreased libido, loss of ability to achieve orgasm) related to the situation pre-paroxetine treatment was reported in 3 (10%) male patients during the whole treatment period. The frequency of seizures was unchanged. Paroxetine is a safe and effective antidepressant in the treatment of depressed and anxious epileptic patients.