4.12 Convulsions
Rare and very rare, but potentially serious adverse effects
SSRIs may lower the seizure threshold1, especially when combined with other epileptogenic agents such as alcohol or tramadol.
Risk-reduction measures
If an SSRI is to be used in a patient with a history of convulsive disorder then it is important to warn the patient and carers of the risk of convulsions, and monitor the patient carefully. SSRI treatment should preferably be avoided in patients with unstable convulsive disorder.
Concomitant use of other drugs that lower seizure threshold (eg alcohol, antipsychotics, bupropion, mefloquine, and tramadol) should be avoided or the drugs used with care and close monitoring of the patient.
Treatment
Treatment with SSRIs should be stopped if seizures develop or the seizure frequency increases.
- The point at which the excitatory (seizure-inducing) impulses upon the brain outweigh the inhibitory (seizure-reducing) impulses, leading to a seizure. A substance which reduces the seizure threshold increases the probability that a stimulus will produce a seizure, especially in those with neurological predisposition to seizures, such as sufferers of epilepsy.↩