Managing Emotional Side Effects of Antiepileptic Medications in Children

Q: Managing Emotional Side Effects of Antiepileptic Medications in Children

Hello everyone： Feelings of low mood and depression, along with frequently biting and peeling the skin on your fingers until they bleed, may not necessarily be caused by Divalproate. <br>In my clinical experience, I have not encountered this, and it is not mentioned in textbooks.

Medication Consultation

Dear Dr.
Wu,
After my child started taking the antiepileptic medication (Divalproate sodium 250mg & 500mg), he has been experiencing low mood, depression, and often bites and peels the skin on his fingers until they bleed.
We consulted a doctor who suggested that the child enjoys the pain, but no medication was prescribed for this behavior.
This has been ongoing for three years.
Friends around us have suggested that it might be obsessive-compulsive disorder (OCD) and that medication treatment is necessary.

However, my child is already on multiple medications, including the antiepileptic drug and Risperidone.
If we were to add medication for OCD, such as fluoxetine, would there be any concerns regarding drug interactions? Additionally, could the antiepileptic medication potentially be causing these behaviors?
If there have been no seizures for two to three years, is it advisable to reduce the dosage? Reducing by 250mg seems significant, especially since the only available dosages are 250mg and 500mg.

Thank you for your guidance.

KK, 40~49 year old female. Ask Date: 2022/07/27

Dr. Wu Enliang reply Psychiatry

Hello everyone: Feelings of low mood and depression, along with frequently biting and peeling the skin on your fingers until they bleed, may not necessarily be caused by Divalproate.
In my clinical experience, I have not encountered this, and it is not mentioned in textbooks.
Currently, there are new medications for obsessive-compulsive disorder (OCD) that are less likely to have drug interactions, but if it is not OCD, it is advisable to consult a child and adolescent psychiatrist.
This medication is also available in liquid form, which allows for easier dosage adjustments, so there is no need to worry about being limited to a single adjustment of 250 mg.
Dr.
Wu Enliang.

Reply Date: 2022/07/27

More Info

Managing emotional side effects of antiepileptic medications, particularly in children, is a complex issue that requires careful consideration of both the medications involved and the psychological well-being of the child. In your case, the child has been taking Divalproate sodium, which is commonly used to treat epilepsy, and has exhibited symptoms such as emotional low mood, depression, and self-harm behaviors like biting their fingers. These symptoms can be distressing for both the child and their caregivers.

Firstly, it is important to recognize that while Divalproate sodium is effective in controlling seizures, it can also have side effects, including mood changes. Although the literature does not explicitly link Divalproate to the specific behaviors you described, it is known that antiepileptic drugs (AEDs) can influence mood and behavior in some individuals. The emotional side effects can sometimes be mistaken for other psychiatric conditions, such as obsessive-compulsive disorder (OCD), which your friends have suggested. It is crucial to consult with a child psychiatrist or a pediatric neurologist who specializes in epilepsy to evaluate the child’s symptoms comprehensively.

Regarding the potential for drug interactions, combining multiple medications can indeed lead to complications. In your case, the child is also taking Risperidone (Risperdal), which is an antipsychotic often used to treat irritability associated with autism and other behavioral disorders. If you consider adding an antidepressant like Fluoxetine (Prozac), it is essential to discuss this with a healthcare provider. While newer antidepressants generally have a favorable safety profile, they can still interact with other medications, including AEDs. The healthcare provider can assess the risk of interactions and monitor the child closely if any changes to the medication regimen are made.

As for the tapering of Divalproate sodium after two to three years of seizure control, it is generally advisable to do so gradually. A reduction of 250 mg at once may be significant, especially if the child is only on doses of 250 mg and 500 mg. The tapering process should be individualized based on the child’s response to the medication, seizure history, and overall health status. A healthcare provider can help determine the appropriate tapering schedule, ensuring that it is done safely and effectively.

In summary, managing the emotional side effects of antiepileptic medications in children requires a multidisciplinary approach. It is essential to work closely with healthcare professionals to evaluate the child’s symptoms, consider potential drug interactions, and develop a safe tapering plan for medications. Regular follow-ups and open communication with the healthcare team can help ensure the child’s emotional and physical well-being while managing their epilepsy effectively.

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