Can Seizure Medication Cause Personality Change? Understanding the Impact of AEDs

For many people with epilepsy, controlling seizures is life-changing, but it's important to recognize the potential side effects. Approximately 15-20% of individuals taking antiepileptic drugs (AEDs) may experience psychiatric adverse effects, which can sometimes cause personality change. Understanding this link is the first step toward effective management and improving overall quality of life.

Quick Summary

This article explains how certain antiepileptic drugs (AEDs) can impact a person's behavior, mood, and emotional state. It explores the neurological reasons for these changes, details which medications are commonly associated with these effects, and outlines strategies for mitigation and collaborative management with a healthcare provider.

Key Points

• AEDs can cause personality change: Antiepileptic drugs work by altering brain chemistry, which can lead to behavioral and psychological side effects that impact a person's mood and personality.

• Certain medications carry higher risk: Some AEDs, such as levetiracetam (Keppra) and topiramate (Topamax), are more frequently associated with specific side effects like irritability, aggression, or cognitive dulling.

• Dosage and polytherapy are influential: The risk and severity of behavioral side effects are often linked to higher doses and taking multiple medications simultaneously.

• Changes can be managed: Side effects are often reversible through dosage adjustments, switching to a different medication, or combining with other therapies like antidepressants or counseling.

• Individual response varies: Every person reacts differently to medication; an individual's unique brain chemistry and history of mental health play a significant role.

The Neurological Basis for Behavioral Changes

Antiepileptic drugs (AEDs), also known as antiseizure medications (ASMs), function by altering the complex electrical and chemical messaging systems within the brain. Their primary purpose is to reduce the excessive neuronal excitability that causes seizures. However, this dampening effect can also influence other critical brain functions, including those related to mood, emotion, and behavior. The intricate web of neurotransmitters, such as GABA (an inhibitory neurotransmitter) and glutamate (an excitatory one), is directly affected by these medications.

There are two main reasons why AEDs can cause personality-related side effects:

• Direct Neurochemical Impact: The very mechanisms used to prevent seizures can directly alter the neurochemical balance that governs mood and behavior. For example, enhancing GABAergic (inhibitory) activity can lead to depression, while activating effects might trigger hyperactivity or irritability.
• Forced Normalization: This complex and rare phenomenon occurs when effective seizure control, particularly of frequent, small epileptic discharges, paradoxically leads to the emergence of psychiatric disturbances. The theory suggests that the underlying brain activity was masking the psychiatric issues, and when controlled, the underlying condition surfaces.

Common Behavioral and Psychological Side Effects

Personality-related changes can manifest in various ways, ranging from subtle shifts to more severe issues that significantly impact daily life. These are some of the most frequently reported side effects:

• Irritability and Aggression: Some AEDs, most notably levetiracetam (Keppra), are known to cause increased irritability, aggression, and agitation in a subset of patients. This can be particularly distressing for both the individual and their family, who may witness what feels like a fundamental shift in personality. This is often colloquially referred to as "Keppra rage".
• Depression and Anxiety: Many AEDs can cause or worsen symptoms of depression and anxiety. An FDA warning exists for many AEDs concerning the potential, though rare, risk of suicidal thoughts and behaviors. Some drugs, however, have mood-stabilizing properties that can be beneficial.
• Cognitive Difficulties: Impaired cognitive function can indirectly lead to personality changes. Problems with memory, concentration, and word-finding, often associated with drugs like topiramate (Topamax), can cause frustration, social withdrawal, or a perceived decrease in mental sharpness.
• Hyperactivity and Restlessness: These effects are particularly noted in children taking certain AEDs but can also occur in adults.

Comparing Behavioral Profiles of Seizure Medications

Different AEDs have varying risk profiles for behavioral side effects. While individual reactions differ, some general trends can be observed.

Medication (Trade Name)	Associated Behavioral Side Effects	Notes on Effect	Citation
Levetiracetam (Keppra)	Irritability, aggression, mood swings, depression, agitation	One of the most frequently cited AEDs for behavioral issues. Effects can emerge at any point during treatment.
Topiramate (Topamax)	Cognitive slowing, confusion, word-finding difficulty, psychosis	Cognitive effects are a primary concern, which can impact social interactions and perceived personality.
Lamotrigine (Lamictal)	Generally favorable mood profile, sometimes used as a mood stabilizer	Less likely to cause negative mood side effects than levetiracetam, and some studies suggest an improvement in mood symptoms.
Carbamazepine (Tegretol)	Mood stabilizing effects, but can cause irritability or cognitive impairment at high doses	Can have positive psychotropic effects but requires careful monitoring of dosage.
Valproic Acid (Depakote)	Mood stabilizing effects, but can cause weight gain and tremor	Often used in bipolar disorder due to its mood-stabilizing properties.

Factors Influencing the Risk of Behavioral Changes

Several factors can influence the likelihood and severity of behavioral side effects:

• Dosage: Higher doses of AEDs are more likely to cause adverse effects. For this reason, physicians typically start with a low dose and increase it gradually.
• Polytherapy: Taking multiple AEDs, often necessary for complex cases of epilepsy, can increase the total drug load and the compounding of side effects.
• Individual Susceptibility: Every person's brain chemistry is unique. Some individuals may be more genetically predisposed to behavioral side effects, especially if they have a personal or family history of mental health conditions.
• Age: The pediatric population may be more vulnerable to certain behavioral side effects, such as irritability and hyperactivity.

Strategies for Managing Side Effects

If you or a loved one notice personality changes after starting or adjusting seizure medication, it's crucial to act promptly. Management requires close collaboration with a healthcare team.

1. Track and Report Symptoms: Keep a detailed journal of behavioral changes, noting their frequency, severity, and any potential triggers. Share this information with your neurologist.
2. Adjust the Dose: In many cases, reducing the medication dosage, tapering it more slowly, or spreading smaller doses throughout the day can significantly mitigate side effects.
3. Try a Different Medication: If dosage adjustments aren't effective or compromise seizure control, switching to a different AED with a more favorable behavioral profile may be necessary. Newer generation drugs often have fewer side effects.
4. Consider Adjunctive Therapies: For persistent mood disorders, adding other medications, such as antidepressants or anti-anxiety drugs, may be an option. Psychotherapy and counseling can also help manage the emotional impact.
5. Educate Yourself and Your Support Network: Educating family and caregivers about the possibility of behavioral side effects can help them provide a more supportive and understanding environment.

Conclusion

While seizure medications are essential for controlling epilepsy, they can and do cause behavioral and personality-like side effects in some individuals. These changes are not a character flaw but a direct result of the drug's impact on brain chemistry. By working closely with a healthcare provider, tracking symptoms diligently, and exploring various management strategies, many of these issues can be successfully resolved or minimized. The ultimate goal is to achieve optimal seizure control with the fewest adverse effects, allowing the individual to maintain their health and quality of life.

For more information on epilepsy and managing side effects, the Epilepsy Foundation website is an excellent resource.

Frequently Asked Questions

Can Keppra (levetiracetam) cause aggression and mood swings?

Yes, levetiracetam is one of the most well-known seizure medications for causing behavioral changes like irritability, aggression, and mood swings in some individuals. These are significant considerations that should be discussed with your doctor.

Are personality changes from seizure medication permanent?

For most individuals, behavioral side effects from seizure medication are reversible. They typically resolve after the medication is discontinued, the dosage is reduced, or the individual's treatment regimen is adjusted.

How can I tell if personality changes are from the medication or my epilepsy?

Tracking your symptoms is key. If changes coincide with starting a new medication or altering its dosage, it is more likely the medication is the cause. Discuss your observations with your doctor, who can help distinguish between drug-induced effects and those related to the epilepsy itself or other comorbidities.

Which seizure medications are least likely to cause personality changes?

Some medications, like lamotrigine, are often cited as having a more favorable behavioral profile and are sometimes even used as mood stabilizers. Discussing individual needs with a neurologist is the best approach to finding the right medication.

Can epilepsy itself cause personality or mood changes?

Yes, epilepsy itself, particularly when it affects certain parts of the brain like the limbic area, can be associated with mood and emotional problems, which can be difficult to distinguish from medication side effects. Tracking symptoms is important.

What should I do if I notice a family member's personality changing on their seizure medication?

The most important step is to communicate with their healthcare provider. Family members often notice changes before the individual does. Keeping a calendar or journal of the behaviors can provide crucial information to the neurologist for potential treatment adjustments.

Are behavioral side effects more common in children?

Children and individuals with developmental challenges are sometimes more vulnerable to behavioral side effects, such as irritability, hyperactivity, and poor frustration tolerance, especially with polytherapy or higher dosages.