What Causes Keppra Ineffective After Being Stopped And Reinstated For Treatment Of OCD?

Posted on Mon, 25 Aug 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 25 Aug 2014 Answered on

Thu, 11 Sep 2014 Last reviewed on

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? My psychiatrist told me that what happened is difficult to understand.because after Gabapentin we tried a higher dosage of Keppra during more than one month without results.

Answered by Dr. Jonas Sundarakumar (6 hours later)

Brief Answer:
Probably due to receptor desensitization

Detailed Answer:
Hello and thanks for writing in.

I had answered one of your earlier queries and so I'm familiar with your case history. Rarely, a medication which had worked very well before can become ineffective after being stopped and reinstated. This is most likely due to receptor-level changes such as receptor desensitization. I have seen this phenomena more commonly with antipsychotic medications, but it can happen with mood stabilizers too.

In the current scenario, it is unlikely that Kreppa is going to regain its full efficacy shortly. There is a possibility that after a break of a few months, Kreppa could regain its efficacy, but this may take a while. So, in your situation, I think it would be a better idea to gradually stop Kreppa and start a different class of anti-obsessive medication.

Best wishes,
Dr. Jonas Sundarakumar MBBS., DPM., MRCPsych.(U.K.)
Consultant Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar