AED Psychiatric Effects — RACP Adult Medicine MCQ

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EasyNeurologyAED Psychiatric EffectsRACP Adult Medicine

A 58-year-old man with epilepsy on levetiracetam develops significant psychiatric adverse effects including severe irritability, aggression, and depression. What antiepileptic drug has the lowest risk of psychiatric adverse effects?

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Correct answer: E — Lamotrigine

Levetiracetam commonly causes psychiatric adverse effects (irritability, aggression, depression, anxiety) in up to 10–15% of patients. Lamotrigine has the most favourable psychiatric profile among AEDs and may even have mood-stabilising properties (it is used in bipolar disorder). Other AEDs with higher psychiatric risk include topiramate (cognitive dulling, depression), phenobarbitone (depression), and vigabatrin (depression, psychosis). When switching from levetiracetam for psychiatric reasons, lamotrigine is an excellent alternative.

Reference: eTG – 2025 – Neurology; AMH – 2025 – Antiepileptics