Antidepressant-Related Seizure Risk

Introduction to Seizure Risk

• Bupropion should be explicitly avoided in patients with seizure concerns, as it lowers seizure threshold and is contraindicated in seizure disorders, according to the American Academy of Family Physicians 1

Patient Selection and Antidepressant Initiation

• For patients without seizure history, the American Academy of Pediatrics recommends starting with sertraline, citalopram, escitalopram, or fluoxetine, as these agents have seizure risk indistinguishable from baseline population rates 2

Special Populations

• For patients with 22q11.2 deletion syndrome, standard antidepressants can be used but require "start low, go slow" dosing due to inherently lowered seizure threshold, as recommended by the American College of Medical Genetics and Genomics 3, 4

Risk Factors for Seizures

• Predisposing factors, such as history of epilepsy or previous seizures, brain damage or structural lesions, alcohol or sedative withdrawal, and multiple concomitant medications, significantly amplify seizure risk, according to the American Academy of Family Physicians and the American College of Medical Genetics and Genomics 1, 3