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.

Anticonvulsants

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:

• Antiepileptics
• NSAIDs or non-steroidal anti-inflammatory drugs (ibuprofen or naproxen)
• Antimalarials
• Steroids^2-3

Antidepressants

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:

• Antidepressants
• Antianxiety medicines such as diazepam (Valium)
• Exercise
• Psychotherapy
• 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

Antipsychotics

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)
• Antidepressants

Steroids may help treat some forms of psychosis and make other types worse.