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Can Keppra be replaced with Gabapentin for OCD?

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Practicing since : 2003
Answered : 2190 Questions
I was until three months ago on treatment for anxiety and also for OCD. I was taking Keppra as mood stabilizer (1000 mg), Lexapro (the same dose during four years), Klonopin 1 mg and Amisulpride 100mg. My psychiatrist changed Keppra to Gabapentin 600 mg, because Keppra makes me feel a little bit tired and angry. The OCD reappeared with this switch to Gabapentin, and i don't understand why. Could it be the difference in the dosage between Keppra and Gabapentin? Gabapentin was too low? Since then, Keppra stopped working and i have again OCD again, so my psychiatrist decided to try a higher dosage of Lexapro (5mg).
Could my psychiatrist try again in the future Gabapentin? I ask this to discuss with my psychiatrist because i prefer Gabapentin to Keppra because of side effects of this second one, but we don't understand why OCD reappears at Gabapentin 600 mg
Posted Sat, 30 Aug 2014 in Anxiety and Stress
Answered by Dr. Jonas Sundarakumar 3 hours later
Brief Answer:
Clarifications given...

Detailed Answer:
Hello and thanks for writing in.

I have gone through your query in detail and here are my thoughts on this matter.

Firstly, Kreppa( Levetiracetam) is considered as a more potent medication than Gabapentin. But the side affects are also higher with Kreppa. The second point is that 600mg of Gabapentin is relatively lower dose equivalent compared to 1000 mg of Kreppa. So, these could be the possible reasons for worsening of your symptoms after the recent change of medication. There is a possibility for the dose of Gabapentin to be increased in the future.

However, the other thing to keep in mind is that both Kreppa and Gabapentin are primarily antiepileptics / mood stabilizers and have anti-anxiety properties also. But none of these two are primarily anti-obsessive medication.

Lexapro (Escitalopram), on the other hand is an effective anti-obsessive medication. This must be the reason for doctor to increase the dose of Lexapro.

So, you can discuss with your Psychiatrist whether to further increase the dose of Lexapro, if necessary or whether to try increasing the dose of Gabapentin itself.

Dr. Jonas Sundarakumar MBBS., DPM., MRCPsych.(U.K.)
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