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Psychiatric side effects associated with AED usage

  • Among paediatric and adult patients with epilepsy, about 30% (newly diagnosed cases) to 50% (resistant cases) suffer from complex psychiatric, behavioural and other symptoms1
  • Patients with history of a psychiatric condition, absence seizures, intractable epilepsy, or frontal lobe epilepsy are more likely to develop PBSE2,3

Psychiatric side effects associated with levetiracetam

  • Common psychiatric (≥1/100 to <1/10) AEs associated with LEV are depression, hostility/aggression, anxiety, insomnia, nervousness / irritability4
  • Psychiatric behavioural side effects (PBSE) with LEV are more common in children than adults4
  • Most of the behavioural/psychiatric AEs observed with LEV are mild to moderate in severity5
  • Very low number of patients discontinued LEV in both randomised controlled trials and observational studies5
  • Slow titration of LEV is advisable in patients with past psychiatric history6

Summary of aggression-related behavior incidence from AED labels

AEDs are listed in alphabetical order. 
Adverse drug reactions (ADRs) frequencies are defined as: 
Very common ≥1/10; Common ≥1/100 to <1/10; Uncommon ≥1/1000 to <1/100; 
Rare ≥1/10000 to <1/1000; Very rare <1/10000; UNK: Not known (cannot be estimated from the available data). For additional details about LEV safety and tolerability please refer to Keppra Prescribing Information.

! – prevalence common in children; * - as an adjuvant; PBO: placebo

Warnings related to psychiatric adverse events associated with levetiracetam:* Levetiracetam may cause psychotic symptoms and behavioural abnormalities, including irritability and aggressiveness. Patients treated with levetiracetam should be monitored for developing psychiatric signs suggesting important mood and/or personality changes. If such behaviours are noticed, treatment adaptation or gradual discontinuation should be considered.

Read more about Keppra


AE: adverse event; AED: anti-epileptic drug; CBZ: carbamazepine; ESL: eslicarbazepine; ETX: ethosuximide; FLB: felbamate; GBP: gabapentin; LAC: lacosamide; LEV: levetiracetam; LTG: lamotrigine; OXC: oxcarbazepine; PER: perampanel; PGB, pregabalin; PHB: phenobarbital; STR: stiripentol; TGB: tiagabine; TOP: topiramate; VAL: valproate; VGB: vigabatrin; ZNS: zonisamide.


  1. Brodie M, et al. Pharmacol Rev 2016;68:563-602.
  2. Stephen LJ, et al. Epilepsy Behav 2017;71:73–78.
  3. Chen B, et al. Eur J Ped Neurol 2017;21: 441-9.
  4. Levetiracetam. Non Central Data Sheet Version Number: 10. Version Date: 6 January 2020.
  5. Halma E, et al. Seizure 2014;23:685–691.
  6. White JR, et al. Neurology 2003;61:1218–1221.

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Keppra is a registered trademark of the GlaxoSmithKline group of companies

PM-NG-LVT-WCNT-200004 Date of preparation: November 2020.