Year: 2026
Type: article
Abstract: People with functional neurological disorder (FND) are prescribed many drugs, yet treatment reviews focus on psychotherapy and physiotherapy and give medication little attention.This narrative review, based on a structured search of PubMed and Embase, asks three questions from a psychiatric perspective: when medication harms people with FND, what it offers for comorbid psychiatric conditions or functional symptoms, and how it should sit alongside psychotherapy.Findings are synthesised narratively; no formal risk-of-bias assessment or certainty grading was performed.Harm is the best-documented effect of medication in FND.Antiseizure drugs are often given for misdiagnosed functional seizures, and each failed drug trial is associated with a longer delay to the correct diagnosis.Benzodiazepine prescribing is common and tends to continue after diagnosis.In emergencies, prolonged functional seizures treated as status epilepticus are associated with escalating doses, respiratory depression and intubation.In case reports, some drugs, including levetiracetam and interferon, were temporally associated with the onset or worsening of functional symptoms.In small studies, withdrawal of antiseizure drugs after a confident diagnosis appeared safe and may itself have reduced attacks.Evidence of benefit is weak.Antidepressants appear to help mainly when depression or anxiety drives the presentation, and there is insufficient controlled evidence to show whether any drug adds to psychotherapy for the functional symptoms themselves.Benzodiazepines have performed no better than psychological approaches in acute settings, and placebo responses are large.Evidence for antipsychotics, drug-assisted interviews, electroconvulsive therapy, ketamine and psychedelics comes from small or uncontrolled studies.There is no good evidence that medication directly treats FND, and insufficient evidence to show whether adding it to psychotherapy improves functional symptoms.Its main roles are as a source of harm to be reviewed and withdrawn, and as support in treating comorbid depression, anxiety and post-traumatic stress disorder alongside psychological and physiotherapy-based treatment.We propose a stepwise approach: confirm the diagnosis, review and withdraw unnecessary drugs, plan emergency care, treat comorbidity, and keep psychotherapy and physiotherapy central.Randomised trials of antidepressants added to psychotherapy, and of deprescribing beyond antiseizure drugs, are research priorities.
Source: Cureus
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7225728696