ABSTRACT
Antiepileptic drugs (AEDs) have been utilized in the treatment of various psychiatric disorders for several decades. As early as the 1960s, it was recognized that AEDs had remedial effects on mood and behavior (1-4). Over time and with an accumulating body of evidence, the psychiatric application of AEDs has grown significantly, with a number of these agents being approved for specific disorders and considered mainstays of treatment. The precise mechanisms of action by which AEDs are useful in patients with epilepsy remain largely unknown. Elucidation of AED mechanisms of action in the context of epilepsy has been challenging because agents may have multiple mechanisms of action and there may be differential interaction at the same molecular target between agents. However, a common link among proposed AED mechanisms of action involves the modulation of excitatory and inhibitory neurotransmission via effects on ion channels and certain neurotransmitters. Although an assumption that the putative mechanisms of action of AEDs are similar for both epilepsy and psychiatric disorders may be premature (5), a clearer understanding of the mechanisms of action of AEDs is necessary and may lead to improved predictions about an agent’s clinical efficacy and safety profiles across the spectrum of psychiatric disorders. Ultimately, this information may contribute toward targeted treatment interventions with a higher likelihood of response and a subsequent improvement in patient psychosocial functioning.
