Side Effects of Anticonvulsants / Mood Stabilizers - The Good, The Bad and The Funny. From People Who Have Taken These Crazy Meds...and SCIENCE!

Remember: Nobody on this site is a doctor,
therapist, or a pharmacist. Know your sources!
Crazy Meds is not responsible for the content of sites we provide links to.
We like them, but what's on those sites is their business, not ours.
Common Side Effects of Anticonvulsants / Mood Stabilizers
There are side effects common to all anticonvulsants. Some of
these extend to mood stabilizers of other classes (lithium,
atypical antipsychotics) so some of those
meds with common effects will be mentioned in passing for members of our
bipolar reading audience.
Here are the most prevalent, notable or ones you really have to
watch out for:
Two are lethargy
and photosensitivity. No more getting up early, going outside and getting all tanned once
undergoing treatment with anticonvulsants, or any form of mood stabilizer, as you'll want to sleep more and must
avoid prolonged exposure to strong sunlight. Some are worse than others, but since so many
of us in the bipolar and epileptic spectra go Gothic anyway it seems a pointless warning.
The lethargy is especially bad with lithium and anticonvulsants and is
only going to get somewhat better with time. The very nature of these medications is that they slow down
your brain to fight your mania or to prevent you from having seizures. In doing so they
also wind up slowing down your metabolism. Well, duh. This sucks no matter which disorder
they are fighting. With epilepsy you wind up slower than a normal person is.
With Bipolar 1 you end up slightly slower than a normal person is after being used to being
better than a normal
person is. It makes it all the more confusing and frustrating in the realm of Bipolar 1
because you have no idea as to what a standard amount of energy and motivation is supposed
to be in the first place! The questions "Is this normal? What
is normal like? Is this how I'm supposed to feel?" and infinite
variations on that theme come up on bipolar support fora day after freaking
day because everyone in the bipolar spectrum thinks they are a unique
snowflake and doesn't bother to read any of the previous posts. The
answer is - that is why you also need to see a therapist.
Furthermore these meds aggravate the ADD symptoms that come along with bipolar, so while
you're on the road to recovery in getting your mood swings in check, it seems like your
mania isn't getting much better because after all because the mood stabilizers are making
ADD symptoms worse. Go on, compare an ADD self-diagnosis with a Mania self-diagnosis. Try
to tell them apart if they didn't have a title on them. Sometimes Provigil
(modafinil),
Strattera (atomoxetine HCl) or other medications need to be used to counteract
the lethargy and ADD aggravation of anticonvulsants or lithium.
Be careful, though, both meds can trigger mania or seizures. The odds
are such where it's not all that likely, but it's still possible for either
med.
Anticonvulsants have a reputation for weight gain, but only
four of the FDA-approved
mood stabilizers, lithium, Depakote (divalproex
sodium) (and the rest of the
valproate family, but only Depakote has
official approval to treat bipolar mania),
Seroquel (quetiapine) and Zyprexa (olanzapine), have serious weight gain issues.
Zyprexa and Seroquel are antipsychotics.
None of the approved or off-label anticonvulsants has similar issues. Yet everyone freaks out over gaining weight. Well,
except for the lithium and Depakote variants, anticonvulsants
rarely cause you to gain weight. It can still happen, but anything can happen with
psychiatric medications. The real culprits with weight gain tend to be the
antidepressants. Doesn't that cheer you up some? Topamax(topiramate)and Zonegran (zonisamide) will often cause you to lose weight, and people clamor
for them, just as often with disastrous results to their mental health.
Most will mess with your memory and cognitive processes
- at first. Although Topamax(topiramate)and Zonegran (zonisamide)
are by far the worst offenders in that category. Notice something, the ones that make you
skinny also make you stupid. Hence my labeling them as "supermodel drugs."
Unless you're taking Keppra (levetiracetam) you will no longer experience the
crystal clear thinking you often have with certain manias where everything makes
total sense. Believe me, it's a fair trade to no longer make the utterly stooooopid
decisions you can make when manic that seemed like such good ideas at the time. Your
credit report will thank you for it. It's just that you will be stupid about little
things, like leaving your cell phone at home when you go out. Bipolar mania makes you
stupid about big things, like buying 50 acres of bushland in Australia, like I did. All in
all I'll take the little stupidity of anticonvulsants over the grandiose stupidity of
euphoric mania or the self-destructive stupidity of depression and dysphoric mania. Plus
the stupidity of anticonvulsants lessens over time, while bipolar stupidity gets worse
over time. I've found trace mineral supplements to help greatly lessen the impact of
Topamax(topiramate)& Neurontin's
(gabapentin) stupid memory tricks, and the
effect of trace minerals on memory is backed up by a variety of studies,
mostly dealing with aging and strokes. I'll be
discussing this in more detail in a section on supplements I plan on
writing.
Expect your dreams to be different. I can't tell you how they will be different, just
that they will be. Maybe they'll be different in a good way,
maybe in a really bad way (e.g. nightmares). Not necessarily forever, but for some time. Once I started taking
Topamax(topiramate)my dreams changed to being a replay of what I did each day. That was it. The
sequence was different, and it was like watching it on the world's most boring TV channel,
but that was it. What little I did each day was played out again each night for about
a
year. It was really difficult to tell when I was awake and when
I was asleep. Previously I had the most baroque dreams you can imagine
night after night. In Mouse's case Topamax(topiramate)made her have the same
freaking dream every night.
Trust me, nothing messes with
your dreams like some form of antipsychotic
or an anticonvulsant.
All of the anticonvulsants deplete you of folic acid. Which means you should take a
folic acid supplement, right? Sure, but not too much folic acid, because according to one
double-blind study done in 1967 with Depakene
(valproic acid) and epilepsy[1],
patients taking more than 1,000mcg of folic acid along with their Depakene
(valproic acid) started
experiencing increased seizure activity. There have been a couple more recent studies done
that weren't double-blind that were inconclusive. Does this apply to bipolar and to all of
the anticonvulsant mood stabilizers? Maybe. Play it safe, take no more than 800mcg in
folic acid a day in the form of supplements. That's more than plenty to cover the
depletion from the meds as well as aid in potential mood stabilization.
If you're pregnant and nursing, talk to your doctor extra long about this
issue. Everyone should talk with their doctors about any supplement
regardless.
All of the anticonvulsants also mess around with girly hormones, just to varying
degrees. While you can expect things like menstrual cycles being disrupted and the like,
or positive benefits like PMS or PMDD symptoms being lessened, if you're taking birth
control pills you must discuss the interaction of these meds with The Pill with your
OB-GYN. You may need a stronger pill, a weaker pill, a birth control bill
that works with different hormones, or you may have to ditch the birth
control pill entirely and use something else. PMS and PMDD symptoms can just as easily be
worsened as they can be improved. Oh, and guys, we have girly hormones too. The odds of
our being affected are not as great, but it is possible. Topamax(topiramate), Tegretol (carbamazepine USP) and
Trileptal (oxcarbazepine) are the worst when it comes to The Pill and your own girly hormones, while
Lamictal (lamotrigine) can be interfered with by birth control pills or even your own monthly cycle.
This is something where your OB-GYN and your neurologist and/or psychiatrist
need to be talking with each other.
They also mess around with our manly
hormones. Tegretol (carbamazepine USP)
in one study and the valproates
in another are shown to be the worst offenders for men. Even women
can have
problems with valproates during puberty. Of course epilepsy itself
is a huge factor in hormonal wackiness. So it's little surprise that
the anticonvulsants mess around with hormones. Again the other
anticonvulsants probably play a part in hitting testosterone, but the
popularity of Tegretol (carbamazepine USP) and
valproates has them being studied more.
The anticonvulsants are the pickiest and most sensitive of all medications to
interactions with other drugs, foods, vitamins, tobacco, the hormones of the menstrual
cycle, the seasons of the year, and just about anything you can imagine.
Lamictal (lamotrigine) is far
and above the most sensitive of the anticonvulsants in this regard. Sometimes these things
can make a med work better, sometimes worse. And if you're on a cocktail, the same thing
could be making one med work better and one med work worse. Take smoking, for instance.
Lots of us smoke. Smoking actually makes Tegretol
(carbamazepine USP) work better. Initially at any rate, but that's
just enzyme-induction fu. It lessens the effects of Topamax(topiramate).
If you drink alcohol expect a change if you mix booze and anticonvulsants. Like the
dreams I can't tell you what kind of change, just that it will be different. This applies
to lithium as well. Maybe you'll get drunk faster. Maybe you'll be able to hold less
liquor. Maybe it will take a lot more to get you drunk. Maybe it will feel different.
Maybe it will be some combination of effects. One thing is fairly common - the hangovers
tend to be a lot worse and last a lot longer. One person taking
Trileptal (oxcarbazepine) reported a
three-day hangover after a few glasses of wine one night. That's an extreme case, but it
illustrates the point well. I suggest that you abstain from drinking if you take
anticonvulsants, or at least keep it to a bare minimum on just a very few occasions.
Anticonvulsants and lithium are just too picky about booze to go mixing the two too often.
So even if you take your meds religiously, if you take anticonvulsants too close to when
you ate it is quite possible that they will vary in efficacy from meal to meal. This is
where it helps to be slightly autistic and cook once a week and eat the same thing day
after day at the same time and take meds on the clock between meals. Unless you're
supposed to take your meds with meals, of course.
Anticonvulsants are rash medications. No, they won't make you go out and do stupid
things without thinking about it first, quite the opposite. Instead you'll be getting a
lot of rashes. And fungal infections. And acne. Lithium can make you break out like it's
two weeks before the senior prom and you still don't have a date. Since increasing
my dosage of Neurontin (gabapentin) I need to stock up on antifungal lotion whenever it goes on sale,
and I cover myself in the drugstore-house-brand version of Gold Bond medicated body powder
every day. It helps. Check out the PI sheets and you'll see the side effects. Now if you
get either hives or you get a rash and a fever at the same time, it's off to the emergency
room with you. And bring all your meds in their bottles. But if it's just a rash
and no fever, then it's off to the drugstore to get the appropriate ointment. If the rash
doesn't go away, or gets worse, call your doctor about it, as some of these skin problems can get
serious, especially with the rashest of all the anticonvulsants -
Lamictal (lamotrigine). But any
anticonvulsant can give you
Stevens-Johnson syndrome,
a.k.a. the Lamictal Rash.
Stevens-Johnson isn't the only rash that can
kill you. Among others there's Toxic Epidermal Syndrome (TEN).
A.K.A. FLESH EATING VIRUS. OK, it's really a flesh-eating bacteria,
but everyone freaks out more with FLESH EATING VIRUS. TEN appears as a
freaky rare side effect for many of the anticonvulsants, and it's not so
much that the anticonvulsant gives you the bacteria, but makes you way
more susceptible to it. Believe it or not, those little buggers are
around us all the time, ready to eat us for dinner. But our skin is
usually in good enough condition to make us unappealing to them.
Unless some anticonvulsant acts as a meat tenderizer. Jonathan wrote
me to report he had to be treated for TEN after taking
carbamazepine. Folks, any sort of skin
weirdness combined with a fever needs medical attention if you're taking an
anticonvulsant.
However, there is some good news on the skin
front. It seems that Topamax(topiramate)can be good for your skin in one way,
it appears to old
scars heal. OK, so I've checked my old scars. The most
noticeable is, of course, even more noticeable now. Good old
paradoxical reaction there. But many others do appear to be vanishing.
Now I'm not a good test subject for this, as I don't get much in the way of
scarring and even my tattoo began to fade long before I took Topamax.
Yet the scars I did have before weren't going away, so there may be
something here after all.
In any event consider going hypoallergenic if
starting anticonvulsant therapy. Get rid of scented soaps, fabric
softeners and similar products. Anything that will reduce the chance
of a false-positive for a problematic rash will make your life easier.
Not only do they mess with your skin, they mess with your teeth and gums. It doesn't
matter that I brush and floss and use antiseptic mouthwash after each meal, I still get
periods where my gums bleed. Other people report increased susceptibility to cavities,
teeth that chip more easily and the like. Calcium supplements may help to prevent the
chipping of the teeth, but everything else requires that you inform your dentist that you
take anticonvulsants and that the side effects include these various dental problems.
For all that they mess with your outsides,
they can mess with your insides just as much. All anticonvulsants
carry the risk of
aplastic anemia
and
agranulocytosis
- in plain English they'll screw up your red blood cells and white blood
cells respectively. These are rare, but still real and potentially
deadly risks. Tegretol (carbamazepine USP)
carries the greatest risk for agranulocytosis, and it is recommended you
have regular blood work for it. Should I point out that Mouse has had
both of these problems? You'd have guessed it anyway. A couple
of readers of this site have had one of each as well. So any weird
bruising that you can't explain (the aplastic anemia) or fever and constant
infections (agranulocytosis) needs to be dealt with immediately. As in
seeing any doctor today.
They will stuff up your nose and sinuses. At least someone on about.com's bipolar
support forum had a
good explanation for this effect. Her take on anticonvulsants and lithium
interacting with various endocrine systems explains everything - skin, teeth, hair,
weight. Between the anticonvulsants and my minor dust mite and mold allergies I have
no idea why I wake up each morning with a stuffed up nose. All I do know is that I
couldn't take Sudafed or anything else that contains pseudoephedrine, let alone real
ephedra, as both are contraindicated for the bipolar and the epileptic. Not that I need
to, my stuffiness isn't that bad, but if yours is, no Sudafed for you if you're taking
these meds for either bipolar disorder or epilepsy. So what can you do besides blow, blow,
blow your nose? Here's a little Yoga trick I've found to be quite useful: Cross your arms
in front of you as if you're hearing something don't like, only put one arm in front of
the other and make your hands into relaxed fists, one fist resting in front of one elbow,
the other behind the other elbow. It doesn't matter which arm is in front first, but I
start with my left arm in front of my right arm each morning for some reason. Then place
your right fist in your left armpit, keeping your left fist on your right elbow. Now
inhale and exhale slowly and deeply through your nose. You'll start to feel your left
nostril and sinus clearing. Keep breathing until that side is clear. Then repeat the
process for the right side. I do this once, sometimes twice a day and I don't have to keep
blowing my nose so often, just first thing in the morning to clear it out prior to doing
my little Yoga trick.
And it that's not enough for you, there's always the nose enema. I'm
sorry, the very idea of this thing this freaks me out to know end.
It's just a simple saline solution in a little bulb that you squirt up your
nose to irrigate your sinuses. It worked for Mouse, it's worked for a
few correspondents of mine and I don't ever want to see or read about anyone
using it ever again. I know it works. You can get it in a drug
store. But for me - ick, gross, don't tell me about it!!!
And to cap it off, they mess with your hair. The
valproate and lithium families are the
worst when it comes to hair interaction, but all anticonvulsants can change the nature of
your crowning glory. Hair thinning is the most popular side effect, especially with
lithium and the various flavors of Depakote (divalproex
sodium). But they and other anticonvulsants can also
cause your hair to curl when it was straight, straighten when it was curly, frizzle, or
even get thicker and reverse baldness. When it comes to anticonvulsants, damn near
anything is possible. They haven't done anything to my hair, it's as out-of-control as
ever. Every day is anime hair day. Trace mineral supplements may help reduce the
impact on your hair, but the studies I've found indicate that they won't
do squat for your hair. You should be taking them anyway for your memory and to help improve
symptoms, so any work they do with your hair is just an improbable bonus.
The Overlords of the 12 Zernox Galaxies have compelled me
through messages in the Sunday Chronicle to beg you for funds to help squash the Arachnoid uprising.
So if this site has been of use and/or amusement to you, we'd be grateful if you could donate some cash.
Take care of yourself, and keep taking your crazy meds!
Jerod
If you still have unanswered questions about this or other medications,
including which one is, or combination of meds are the best for you, your best
bet is to ask on Crazy
Meds Talk. Better yet, if you want to let the world know how they
worked out for you and want to help out others in their quest for the correct
meds, join the party.
If you want to discuss your issues, I suggest checking out one of
the various
support groups online.
Otherwise, if you're letting me know about how much you like or hate the site,
or need to let me know about medication effects in private, then just drop
a note to jerod23 at gmail dot com Honestly, I usually don't have a
lot of time to answer e-mail these days. The snide autoresponse
message that may or may not hit your mailbox is going to tell you the same
thing.
Another problem is that you may not get a response even if I wanted to send you
one. You see, so many dickweeds with malicious intents and too much time
on their hands have appropriated the crazymeds.org domain name to use for their
spam, viruses and the like. Subsequently some lazy-ass e-mail protection
software authors just go by the domain name, and not the IP address. So
I've been blacklisted because of the actions of others. Or the software
just doesn't like the domain name because of the "crazy" and/or "meds." Or
your question about a particular medication will set off spam flags. So
the e-mail just wouldn't go through regardless. Sorry.
Hey, did you find this page all by itself through Google or some
other search engine? Great! But to really appreciate the entire site, you need to
start here.
[1] The Lancet 1967 1:1086 Reynolds, EH "Effects of folic acid on the mental state and fit frequency of drug treated epileptic patients."
All rights reserved. No warranty is expressed or implied in this information.
Consult one or more doctors and pharmacists before taking, or changing how you take any
neurological and/or psychiatric medication. Your mileage may vary. What happened to us won't necessarily
happen to you. Nobody on this site is a doctor,
therapist, or a pharmacist. We don't portray them either here or on
TV. Only doctors can diagnose and treat an illness. Some doctors tend to get pissed off
by patients who know too much about medications, so tread lightly when and where
appropriate. Diagnosing yourself from a website is like defending yourself in court, you
suddenly have a fool for a doctor. Don't be a
cyberchondriac, thinking you have every
disease you see a website about, or that you'll get every side effect from every
medication. Self-prescribing is just as dangerous. All information on this site has been obtained through personal experience,
the experiences of my friends, the experiences of people reported on online support
groups, and from sources that are referenced throughout the site.
Know your sources! As such the information
presented here is not a substitute for real medical advice from your real doctor, just a
compliment to it. No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this
website. All brand names of the drugs listed in this site are the trademarks of
the companies listed after them in the pages about the drugs, even though those companies
may or may not have been acquired by other companies who may or may not be listed in this
site by the time you read this. Always read the PI sheet that comes with your medications
and never ever throw them away. If you didn't get a PI sheet, demand one.
Loudly.
Crazy Meds is not responsible for the content of sites we provide links to.
We like them, or they're paid advertisements, or they're something you should
read to make an informed decision about a particular med. Sometimes
they're more than one of those things. But what's on those sites is their business, not ours.
Very little information about visitors to this site is collected or
saved. And from time to time I do look at search terms used to find it in an effort
to make the information I present more relevant. Use only as directed. Void where
prohibited.
"Everything is true, nothing is permitted." - Jerod Poore
Share on Facebook
