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Epilepsy – Safe Antidepressant Choice — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersEpilepsy – Safe Antidepressant ChoiceSCE Neurology

A patient with well-controlled epilepsy needs pharmacological treatment for persistent anxiety. Which option is generally preferred because it has relatively low proconvulsant risk at therapeutic doses?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Sertraline, with neurological reassessment, after checking contraindications

The best answer is “Sertraline, with neurological reassessment, after checking contraindications”. SSRIs such as sertraline are generally preferred when an antidepressant is required in epilepsy, whereas the alternatives listed have greater recognised seizure liability. “Bupropion” is plausible in a different neurological context, but the decisive findings here argue against it. “Clomipramine” is plausible in a different neurological context, but the decisive findings here argue against it. “Maprotiline” is plausible in a different neurological context, but the decisive findings here argue against it. “Tramadol” is plausible in a different neurological context, but the decisive findings here argue against it.

Reference: NICE NG217 epilepsy recommendations: https://www.nice.org.uk/guidance/ng217/chapter/Recommendations