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Why Causes Keppra To Be Ineffective In Treatment Of OCD?
Question: I was taking until some time ago 1000mg Keppra as mood stabilizer, Klonopin 1mg, Lexapro 2.5 mg and amisulpride (Solian) 100mg. My psychiatrist decided to change Keppra for Gabapentin, but this med didn't worked and suddenly an old OCD/phobia reappeared. It was under control until the change of Keppra for Gabapentin. But the most strange is that when my psychiatrist decided to go back to Keppra, the problem was not resolved and the symptom of OCD/phobia stayed. My question is: why the problem was not there with Keppra 1000mg, it appeared with the change of antiepileptic (to Gabapentin) BUT it NOT disappeared going back to Keppra (at the same dosage, 1000mg), while Keppra was working BEFORE the change and for some four years? Is there any kind competition between meds (in the liver and kidneys, since Keppra doen't work in the liver but the other meds do) or receptor desensitization that could explain that Keppra was not able to do the same effect because it was retired for two weeks in the replacement by Gabapentin? A higher dosage of Keppra is needed? My psychiatrist told me that what happened is difficult to understand.
Brief Answer:
wait for 2 weeks more or Try with high dose
Detailed Answer:
Hi,
The problem is not likely with keppra's action.
Please note some facts.
In diabetes medical science know that how insulin deficiency occurs and how it can be treated means exact etiology(cause) of the problem is known so exact treatment is also available.
While in neurological-mental health science exact mechanism of either any disorder or any drug is not known.
Our brain has lots of neurotransmitters and they work indifferent parts in different manner and different coordination.
That's why sometime we can not understand about drug's action as in your case.
Even one medicine in OCD can be helpful in x person and not in Y as brain structures and genetic make up differs person to person.
In your case problem is OCD which is one of the difficult disorders in psychiatry from treatment point of view. Etiology of OCD is not exactly established that we can target it.
You were stable on keppra, with gabapentin not improvement and reintroduction of keppra is not yet effective.
Gabapentin interacts with voltage-sensitive calcium channels in cortical neurons
while mechanism of action of keppra is the drug binds to a synaptic vesicle glycoprotein, SV2A and inhibits presynaptic calcium channels reducing neurotransmitter release and acting as a neuromodulator.
So gabapentine had done some neurochemical changes which might preventing keppra to again work effectively.
Neurotransmitter changes will take place in gradual manner, so you can wait for more 2 weeks to be keppra effective as reverting of changes done by gabapentin can occurs. Or gradual introduction of more dose can be tried to fasten the process.
Keppra is metabolized by kidney so no competition in hepatic metabolism.
Hope I have answered your query,
Regards,
Dr.Chintan Solanki.
wait for 2 weeks more or Try with high dose
Detailed Answer:
Hi,
The problem is not likely with keppra's action.
Please note some facts.
In diabetes medical science know that how insulin deficiency occurs and how it can be treated means exact etiology(cause) of the problem is known so exact treatment is also available.
While in neurological-mental health science exact mechanism of either any disorder or any drug is not known.
Our brain has lots of neurotransmitters and they work indifferent parts in different manner and different coordination.
That's why sometime we can not understand about drug's action as in your case.
Even one medicine in OCD can be helpful in x person and not in Y as brain structures and genetic make up differs person to person.
In your case problem is OCD which is one of the difficult disorders in psychiatry from treatment point of view. Etiology of OCD is not exactly established that we can target it.
You were stable on keppra, with gabapentin not improvement and reintroduction of keppra is not yet effective.
Gabapentin interacts with voltage-sensitive calcium channels in cortical neurons
while mechanism of action of keppra is the drug binds to a synaptic vesicle glycoprotein, SV2A and inhibits presynaptic calcium channels reducing neurotransmitter release and acting as a neuromodulator.
So gabapentine had done some neurochemical changes which might preventing keppra to again work effectively.
Neurotransmitter changes will take place in gradual manner, so you can wait for more 2 weeks to be keppra effective as reverting of changes done by gabapentin can occurs. Or gradual introduction of more dose can be tried to fasten the process.
Keppra is metabolized by kidney so no competition in hepatic metabolism.
Hope I have answered your query,
Regards,
Dr.Chintan Solanki.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Answered by
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