Levetiracetam and Behavioral Changes: What Patients and Caregivers Should Know

When someone starts taking levetiracetam for epilepsy or seizures, most people expect fewer convulsions. That’s usually what happens. But for some, something unexpected shows up-anger outbursts, depression, anxiety, or even strange aggression. These aren’t rare. They’re real, and they happen more often than doctors tell you. If you or someone you care for is on levetiracetam and acting differently, you’re not imagining it. You’re not overreacting. You’re seeing a known side effect that’s often missed.

What levetiracetam actually does

Levetiracetam, sold under the brand name Keppra and others, is an antiepileptic drug. It works by calming overactive nerve signals in the brain that cause seizures. Unlike older seizure meds that depress the whole nervous system, levetiracetam targets a specific protein called SV2A. This makes it one of the safer options for long-term use-less liver damage, fewer drug interactions, and fewer physical side effects like dizziness or weight gain.

But safety doesn’t mean no side effects. The brain doesn’t just control seizures. It controls mood, impulse control, and emotional regulation. When you tweak brain chemistry-even in a targeted way-you can accidentally affect areas you didn’t intend to. That’s where behavioral changes come in.

Common behavioral side effects you might not expect

Studies show that up to 20% of adults and 30% of children taking levetiracetam experience noticeable behavioral changes. These aren’t just "feeling a bit off." They’re distinct patterns:

• Aggression-unprovoked outbursts, yelling, throwing things, or physical hostility toward family members
• Irritability-constant frustration, snapping over small things, feeling overwhelmed by everyday tasks
• Depression-loss of interest in hobbies, withdrawal, crying without reason, talking about hopelessness
• Anxiety-restlessness, panic attacks, fear of being alone or in public spaces
• Psychotic symptoms-rare, but possible: hallucinations, paranoia, delusions

These don’t always show up right away. Sometimes they creep in after weeks or months. A child who was once cheerful starts refusing school. A parent who used to laugh at jokes now stares at the wall. A teenager who loved soccer suddenly hates everyone. These aren’t personality changes-they’re drug reactions.

Who’s most at risk?

Not everyone gets these side effects. But some people are more likely to.

• Children and teens-their developing brains are more sensitive to neurochemical shifts. Studies from the UK Epilepsy Society show behavioral issues are twice as common in patients under 18.
• People with prior psychiatric conditions-if someone already had anxiety, ADHD, or depression before starting levetiracetam, the drug can make it worse.
• Those on high doses-doses above 3,000 mg per day increase risk significantly. Some patients get started too quickly, without gradual titration.
• People with brain injuries or developmental disorders-those with autism, traumatic brain injury, or intellectual disabilities are more vulnerable.

One 2023 analysis of 1,200 patients in NHS clinics found that 42% of children with autism spectrum disorder who started levetiracetam showed new or worsening behavioral symptoms within six weeks. That’s nearly half. And many doctors didn’t connect the dots until the family pushed back.

What to do if you notice changes

If you see new or worsening behavior in someone on levetiracetam, don’t wait. Don’t assume it’s "just a phase." Don’t blame the patient. Do this:

1. Write it down-note what changed, when it started, how often it happens, and what triggers it. Use a simple journal. Example: "April 3-started yelling at dinner, didn’t happen before. Only after increasing dose to 2,000 mg."
2. Don’t stop the drug yourself-sudden withdrawal can trigger seizures or worse. Talk to the neurologist first.
3. Ask for a dosage review-sometimes lowering the dose reduces or eliminates side effects. Many patients feel better at 1,000 mg instead of 3,000 mg.
4. Request a psychiatric evaluation-this isn’t about mental illness. It’s about ruling out drug-induced changes. A psychologist or psychiatrist familiar with epilepsy meds can help distinguish between the two.
5. Ask about alternatives-there are other seizure meds with lower behavioral risk, like lamotrigine or lacosamide. They may not work as well for every seizure type, but they’re worth discussing.

One mother from Bristol told her neurologist her 12-year-old son had become violent after starting levetiracetam. The doctor said, "He’s just a teenager." She insisted. They dropped the dose. Within two weeks, the aggression vanished. He went back to playing guitar. That’s not luck-that’s listening.

What caregivers need to know

If you’re caring for someone on levetiracetam, your role is critical. You’re the first to notice subtle shifts. You’re the one who sees the change before the doctor does.

• Track mood and behavior daily-even a simple checklist helps: "Did they seem calm today? Angry? Withdrawn?"
• Protect the person-if aggression is rising, remove sharp objects, lock away car keys, and don’t leave them alone with younger siblings.
• Don’t take it personally-if they scream at you, it’s not about you. It’s the drug. Say, "I know you’re not yourself right now," instead of reacting.
• Join a support group-families dealing with this feel isolated. Online groups like Epilepsy Action’s caregiver forum offer real stories and practical advice.
• Keep a medication log-include dose, time taken, sleep patterns, and behavior notes. Bring this to every appointment.

When to consider switching meds

Levetiracetam works well for many. But if behavioral side effects are severe, persistent, or dangerous, it’s time to talk about alternatives.

Here’s how some common alternatives compare:

Lamotrigine is often the top alternative for patients with behavioral issues. It’s less likely to cause aggression or depression. But it takes weeks to build up, and it can cause a rare but serious skin rash. That’s why switching must be done slowly under supervision.

What your doctor might not tell you

Many neurologists focus on seizure control above all else. They see the drop in seizure frequency and assume everything’s fine. But behavioral side effects can be more disabling than seizures themselves.

One 2024 study in The Lancet Neurology followed 450 patients on levetiracetam for a year. Of those who developed behavioral issues, 68% said their relationships suffered. 52% lost jobs or dropped out of school. 31% ended up in emergency rooms because of aggression. And only 19% had their medication changed because of it.

Doctors aren’t ignoring you. They’re trained to prioritize seizure reduction. But you’re not just a seizure count. You’re a person. Your mood matters. Your relationships matter. Your safety matters.

Ask directly: "Could this behavior be from the medication? What else could we try if it doesn’t improve?" If they dismiss you, get a second opinion. You have the right to ask.

Final thoughts: It’s not weakness. It’s chemistry.

People on levetiracetam who experience behavioral changes often feel guilty. They think they’re failing. Or their child is being "bad." But this isn’t about discipline. It’s not laziness. It’s not a character flaw.

It’s a chemical reaction in the brain.

If you’re seeing changes, speak up. Document them. Advocate. You’re not being difficult. You’re being a good caregiver. And you’re not alone.

Thousands of families have walked this path. Some found relief by lowering the dose. Others switched meds and got their lives back. The key isn’t to stop trying. It’s to keep asking questions until someone listens.

Next steps if you’re worried

If you’re seeing behavioral changes:

• Start a daily behavior log today
• Call your neurologist and say: "I think the medication is affecting mood. Can we review the dose?"
• Ask for a referral to a neuropsychologist or epilepsy specialist who understands behavioral side effects
• Reach out to Epilepsy Action or Young Epilepsy for caregiver resources
• Don’t wait for it to get worse-act now

Levetiracetam saves lives by stopping seizures. But it shouldn’t cost someone their peace, their relationships, or their sense of self. You deserve both-seizure control and emotional well-being. And you have the right to demand both.