Can I take anxiety meds with Keppra? Understanding Drug Interactions and Risks

October 11, 2025 •

4 min read

An estimated one-third of people with epilepsy also experience anxiety, making the safe management of both conditions a critical concern. A key question for many patients is, "Can I take anxiety meds with Keppra?," a common anti-seizure medication (levetiracetam). Combining medications requires careful consideration and medical supervision to avoid potential side effects, such as increased sedation or altered mood.

Quick Summary

Discusses combining Keppra (levetiracetam) with anxiety medications, including benzodiazepines, SSRIs, and others. Highlights risks of increased sedation, cognitive impairment, and mood changes, emphasizing the importance of healthcare provider supervision and careful dosage adjustment to ensure patient safety and treatment efficacy.

Key Points

Additive Sedation: Combining Keppra with benzodiazepines (e.g., Xanax, Ativan) or other CNS depressants increases the risk of excessive drowsiness and impaired coordination.
Keppra's Own Effects: Be aware that Keppra can independently cause psychiatric symptoms like anxiety and irritability, which could be misidentified or compounded by new anxiety medication.
SSRIs as a Safer Option: Selective Serotonin Reuptake Inhibitors (SSRIs) generally carry a lower risk of severe interaction with Keppra, though monitoring for increased sleepiness is still advised.
Avoid Alcohol: It is recommended to avoid or severely limit alcohol consumption, as it can worsen the CNS depressant effects of both Keppra and many anxiety medications.
Non-Pharmacological Treatments: Therapeutic options like Cognitive Behavioral Therapy (CBT) and mindfulness can be effective for managing anxiety and may reduce the need for additional medication.
Seek Medical Guidance: Always consult your healthcare provider before combining Keppra with any new anxiety medication to ensure safety and effectiveness.

Navigating Anxiety Treatment While on Keppra

Keppra, known generically as levetiracetam, is a widely used antiepileptic drug (AED) for managing various types of seizures. Anxiety is a common comorbidity, and treating it effectively without compromising seizure control or causing adverse reactions is a key clinical challenge. While some combinations of Keppra and anxiety medication can be safe with proper management, others carry significant risks due to overlapping central nervous system (CNS) effects.

The Direct Link: Keppra's Own Psychiatric Effects

Before adding another medication, it is important to recognize that Keppra itself can cause a range of psychiatric and behavioral side effects, including anxiety, agitation, irritability, and depression. In some cases, mood changes can be mistaken for a separate anxiety disorder, while in others, they can exacerbate existing symptoms. Monitoring these side effects with your healthcare provider is the first step before introducing additional therapy.

Interactions with Benzodiazepines

Benzodiazepines are a class of anxiolytic medications often prescribed for short-term anxiety relief or panic attacks. Examples include alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan).

Additive CNS Depression: Both Keppra and benzodiazepines act on the CNS. Combining them significantly increases the risk of side effects like excessive drowsiness, sedation, dizziness, and impaired concentration. This additive effect can impair cognitive function and coordination, making activities like driving or operating heavy machinery extremely dangerous.
Risk of Physical Dependence: Benzodiazepines carry a risk of physical dependence and addiction, especially with prolonged use. Combining them with another CNS depressant like Keppra can further complicate treatment and withdrawal.
Management: If co-administration is necessary, it must be done under strict medical supervision. A doctor may start with very low doses of the benzodiazepine and monitor the patient closely. Some online checkers might indicate no interaction for specific pairs (e.g., clonazepam and Keppra) but caution regarding additive CNS depression is still paramount.

Interactions with Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are a common first-line treatment for generalized anxiety disorder (GAD) and panic disorder. Medications in this class include sertraline (Zoloft) and escitalopram (Lexapro). SSRIs are often considered a relatively safer option for patients with epilepsy, though careful management is still required.

Increased Sedation Risk: Some SSRIs, especially those with more sedating properties, may increase the risk of drowsiness when combined with Keppra, which also causes somnolence.
Rare Seizure Risk: While SSRIs are generally considered to have a low risk of worsening seizures, certain antidepressants might lower the seizure threshold in susceptible individuals, potentially reducing Keppra's effectiveness. However, specific evidence for Keppra is not conclusive, and close monitoring is key.
Hyponatremia: A small risk of hyponatremia (low blood sodium levels) exists when combining SSRIs with certain anticonvulsants, though less common with Keppra compared to others.

Interactions with Other Anxiolytics

Other medications are sometimes used to treat anxiety, each with its own interaction profile with Keppra:

Buspirone (BuSpar): Combining buspirone and Keppra can lead to increased CNS side effects like dizziness, drowsiness, confusion, and difficulty concentrating.
Hydroxyzine (Vistaril/Atarax): As a sedating antihistamine, hydroxyzine adds to the CNS depressant effects of Keppra, increasing sedation and cognitive impairment.
Gabapentin (Neurontin) and Pregabalin (Lyrica): These medications, sometimes used for anxiety off-label, can cause significant additive drowsiness and CNS depression when combined with Keppra.

Comparison of Interactions: Anxiety Meds and Keppra


Medication Class	Example Medications	Primary Interaction Risk	Key Considerations
Benzodiazepines	Alprazolam, Diazepam, Lorazepam	Significant additive CNS depression, sedation, impaired coordination	Use caution; monitor closely; consider short-term use only due to dependence risk
SSRIs	Sertraline, Escitalopram	Increased sedation, rare seizure risk for some antidepressants	Generally safer; monitor for somnolence; minimal pharmacokinetic interaction with Keppra
Buspirone	BuSpar	Additive CNS depression (dizziness, drowsiness)	Monitor closely for increased cognitive side effects
Sedating Antihistamines	Hydroxyzine	Additive CNS depression	Avoid if possible or use with extreme caution due to sedation
Gabapentin/Pregabalin	Neurontin, Lyrica	Additive CNS depression (dizziness, drowsiness, confusion)	Monitor closely; dose adjustments may be necessary

Managing Co-existing Anxiety and Seizures

If you have anxiety and are taking Keppra, a holistic approach is essential:

Start with Non-Pharmacological Interventions: Cognitive behavioral therapy (CBT), mindfulness practices, and lifestyle adjustments can be very effective for managing anxiety without medication.
Monitor Your Symptoms: Keep a detailed journal of your mood and anxiety levels to help your doctor differentiate between Keppra side effects and genuine anxiety symptoms.
Discuss Options with Your Provider: Your doctor can help determine the best course of action. This may involve adjusting your Keppra dose, switching to a different anxiety medication, or opting for a less sedating combination. For patients with a history of mental health issues, a less sedating option may be preferable.

Conclusion

While it is possible to take anxiety medications with Keppra, it is not a decision to be taken lightly. The primary risks involve heightened CNS depression, with a potential for increased sedation, dizziness, and cognitive impairment, especially with benzodiazepines and other sedating anxiolytics. Some SSRIs may pose a lower risk but require careful monitoring. Given that Keppra can cause its own psychiatric side effects, a thorough evaluation by a healthcare professional is crucial to manage both conditions effectively and safely. Never start or stop any medication without consulting your doctor to avoid dangerous interactions or withdrawal symptoms. For more detailed prescribing information, including potential side effects and interactions, refer to authoritative sources like Drugs.com.

Frequently Asked Questions

The main risks are central nervous system (CNS) depression, leading to increased drowsiness, dizziness, confusion, and impaired coordination. This is especially true with benzodiazepines but can occur with other anxiolytics as well.

Combining Keppra (levetiracetam) and Xanax (alprazolam) is generally not recommended unless under strict medical supervision. Both medications can cause significant sedation, and combining them increases this risk substantially.

SSRIs like Zoloft (sertraline) are often considered a safer option for anxiety in patients taking Keppra. While some SSRIs can cause sedation, the drug interaction is typically less severe than with benzodiazepines. Still, it is crucial to consult your doctor for proper monitoring.

Keppra can cause a range of behavioral and mood changes, including anxiety, irritability, aggression, agitation, and depression. These side effects should be monitored closely and reported to a doctor, as they may mimic or exacerbate an anxiety disorder.

Many non-pharmacological therapies can help manage anxiety. These include cognitive behavioral therapy (CBT), mindfulness exercises, deep breathing techniques, and regular exercise. Lifestyle adjustments can also be very effective.

If combining medications, monitor for excessive drowsiness, extreme dizziness, confusion, impaired judgment, or difficulty with motor skills. If any of these symptoms occur, contact your healthcare provider immediately.

Keppra is not an approved treatment for anxiety disorders. While some anticonvulsants are used off-label for anxiety, the evidence for Keppra's effectiveness in treating anxiety is inconclusive, and it can sometimes worsen psychiatric symptoms.