Antiepileptics for psychiatric illness: Find the right match

Theresa M. Gerst, PharmD, Clinical Assistant Professor, Division of Pharmacy Practice, College of Pharmacy, The University of Texas at Austin, Austin, TX

Tawny L. Smith, PharmD, BCPP, Clinical Pharmacy Specialist, Psychiatry, Seton Family of Hospitals, Austin, TX, Assistant Professor, Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX

Nick C. Patel, PharmD, PhD, BCPP, Clinical Pharmacist, LifeSynch, Inc. Las Colinas, TX, Clinical Assistant Professor, Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, GA

Although antiepileptic drugs (AEDs) are used to treat a spectrum of psychiatric disorders, in some instances they are prescribed without clear evidence of clinical benefit or safety. When considering prescribing an AED, ask yourself:

• Does the evidence show the drug is efficacious for my patient’s disorder or symptoms?

• Which adverse effects are associated with this medication?

• What are the advantages of monitoring the patient’s serum drug concentration?

This review provides an evidence-based framework regarding the safe and effective use of AEDs in psychiatric patients.

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How do SSRIs cause sexual dysfunction?

Deepak Prabhakar, MD, MPH, Chief Resident, Outpatient Department, Department of Psychiatry and Behavioral, Neurosciences, Wayne State University, Detroit, MI

Richard Balon, MD, Professor, Department of Psychiatry and Behavioral, Neurosciences, Wayne State University, Detroit, MI

Although selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed and are better tolerated than older antidepressants, side effects such as sexual dysfunction limit patient acceptance of these medications. DSM-IV-TR categorizes medication-induced sexual dysfunction as a type of substance-induced sexual dysfunction. These dysfunctions are characterized by impairment of various sexual response phases.

Estimating the true incidence and prevalence of SSRI-related sexual dysfunction can be difficult. Zimmerman et al compared psychiatrists’ clinical assessments of depressed patients receiving ongoing treatment with results of a standardized side effects questionnaire and found that even though psychiatrists regularly inquired about sexual side effects, on the questionnaire patients reported higher rates of almost all sexual dysfunctions. The incidence of SSRI-induced sexual dysfunction also can be difficult to ascertain because some sexual dysfunctions frequently accompany a primary psychiatric disorder or physical illness. Balon suggested that the incidence of SSRI-associated sexual dysfunction is 30% to 50%, although others have reported higher incidences.

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Recognizing the unheralded heroes of psychiatry

Henry A. Nasrallah, MD
Editor-in-Chief

A large number of individuals contribute in many ways to the process of discovering, applying, and disseminating new psychiatric knowledge. I am, of course, referring to researchers, clinicians, teachers, and advocates who touch the lives of millions of persons who suffer from mental illness every year. This editorial is dedicated to singing the praises of those who quietly contribute to advancing psychiatry.

Patients. Tens of thousands of psychiatric patients sign an informed consent form and volunteer to participate in clinical trials to test new drugs in double-blind, placebo-controlled studies that could lead to FDA approval. Without these volunteers, it would be almost impossible to develop new medications.Research assistants. They are an army of skilled technical workers who do the heavy lifting in animal or human research and put in long hours to collect data or conduct tests. Yet they are rarely recognized for their critical contributions to science and clinical practice.


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