Neuropsychiatric Treatments with Lupus
Neuropsychiatric symptoms are some of the most common signs or side effects of lupus. People with lupus often report seizures, depression, anxiety, clouded thinking, confusion, impaired memory, headaches, and psychosis (auditory, visual, or olfactory hallucinations and delusions).1
The inflammation of lupus frequently attacks the central nervous system (brain and spinal cord) and peripheral nervous system (nerves outside the brain and spinal cord). Lupus may create antibodies that bind to nerve cells or the blood vessels that feed the nerves, stopping blood from flowing to the nerves. In addition, some lupus medications may cause or aggravate existing neuropsychiatric symptoms.
Because the causes of neuropsychiatric symptoms can be so different, the types of treatments you may be prescribed also vary widely. The most frequently used drugs include anticonvulsants, antidepressants, antipsychotics, and antithrombotic agents.
The number of people with lupus who experience seizures varies widely, with international studies reporting anywhere between 6.2 percent and 58 percent.2 Seizures are thought to occur because the inflammation and antibodies created by lupus aggravate the tissues of the brain and spine.
Seizures can be a serious neurological complication of lupus, though many people have no long-term change to their quality of life.3
Many treatments can help prevent another seizure in the future. What you are prescribed will depend on the underlying issue your doctors believe contributed to your seizure. Treatments may include:
- NSAIDs or non-steroidal anti-inflammatory drugs (ibuprofen or naproxen)
Major or clinical depression occurs in about 25 percent of people with lupus and anxiety in about 37 percent. In some people, depression and anxiety are the first symptoms of lupus to appear, leading doctors to speculate that lupus antibodies cause these mood disorders. In other cases, scientists believe depression and anxiety result from the pressures of having a chronic illness. These worries include concerns about the cost of health care, social isolation, unemployment, and worry about dependency on family and friends.4
Dozens of drugs and other treatments exist to help with depression and anxiety, including:
- Antianxiety medicines such as diazepam (Valium)
- Practice good sleep habits
- Find ways to reduce pain5
Since depression is one of the many potential side effects of steroids, your doctor may change or reduce the steroids you are taking.5
Lupus can cause a range of impaired brain functions, from generally clouded thinking and confusion to memory problems and severe hallucinations or delusions. Scientists estimate that two-thirds of people with lupus present with some sort of psychosis at some point in the disease. Heart disease caused by lupus may contribute to these conditions. Drugs to treat lupus-induced psychosis can include some of the same drugs used to treat depression, bipolar disorder or schizophrenia, including:6
- Antipsychotics such as quetiapine (Seroquel) or olanzapine (Zyprexa)
Steroids may help treat some forms of psychosis and make other types worse.
Thrombosis is the process where the body forms a blood clot or thrombus. When the body is working as it should, the thrombosis helps the blood clot when you cut or injure yourself. With lupus, a condition called antiphospholipid syndrome can develop, and the blood clots too much. This prevents blood from flowing normally through the veins, arteries, and capillaries, causing stroke, pulmonary embolism, heart attack, and deep vein thrombosis.7,8
To prevent blood clots, doctors often prescribe one of several medications, including:
- Anticoagulants (heparin, warfarin)8
People with lupus can also develop a condition called thrombocytopenia where the blood does not clot enough because platelet counts are too low. Treatments for thrombocytopenia include:
- Eating more foods rich in B12 and folates
- Blood or platelet transfusion