‹ Classifications of AEDs | AED Overview/Topic Index | List of AEDs ›

Like all crazy meds, antiepileptic drugs (AEDs)/anticonvulsants (ACs) are pretty versatile and are used for practically anything. Neurontin (gabapentin) is a kind of late-20^th century snake oil in that it was used for almost anything a doctor or pharm rep could think of. Unlike ‘actual’ snake oil¹ Neurontin works for its intended purposes and some of its off-label application. Like snake oil the FDA action and civil suits against Parke-Davis (then Warner Lambert, then Pfizer) were the first of many high-profile cases against other drug companies for similar encouragement of off-label prescribing.

Be that as it may, AEDs have plenty of uses, even if they aren’t all FDA-approved. As to the ones that are FDA-approved, there are essentially four basic categories of conditions.

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1.  Epilepsy. Duh.

The types of seizures the FDA approves AEDs to treat can be categorized into two overly-broad categories: generalized and partial.

1.1  Generalized Seizures

“Generalized” means “Both sides of your brain at once. Maybe everywhere, maybe enough places where it may as well be everywhere, and maybe just here and there on both sides of your brain but we’re kinda married to this definition.”

Some generalized seizures are what most people think of when they read or hear the words “epilepsy” and “seizure.” More often than not it’s the kind when you’re flopping all over the place like a fish out of water (clonic seizure), often accompanied by periods of stiff-as-a-board paralysis (tonic seizure). They’re also known by the quaint term grand mal. Another popular generalized seizure is the absence seizure, when you zone out, stare into space, and not move for several seconds to tens of minutes. This is also known as a petit mal. For more information about a way more complicated topic:

• Tonic-clonic seizures
• Absence seizures
• Myoclonic seizures
• Other types of seizures
• Tonic-clonic seizures for neurologists
• Absence seizures for neurologists

1.2  Partial Seizures

“Partial” means “A single, localized area on one side of your brain. It can be the entire hemisphere, but that’s just one side, so it’s partial. Oh, it can also spread to your entire brain.” People tend to be born with generalized seizures, while partial seizures are something you’re born with, or you get from an accident or illness, or no one has a clue as to the cause.
Partial seizures are generally divided into simple and complex.

1.3  Simple Partial Seizures

With simple partial seizures you’re still awake (more or less). Symptoms include all sorts of stuff:

• one or two limbs spazzing out
• wacky visual or other sensory distortions
• strange physical sensations
• emotional responses coming out of nowhere (e.g. sudden fear for no reason)

Simple partial seizures are frequently warnings of impending complex partial or generalized seizures. The latter are called “secondarily generalized seizures” and are lumped in with partial seizures for some reason². This warning is known as an aura, just like migraines. I’m fortunate in that I get these with plenty of time to take some lorazepam, go to bed, and write off the day. While a complex partial seizure is no big deal (unless I break stuff), spending the day in bed sucks a lot less than having a full-on, flopping-around generalized seizure.

1.4  Complex Partial Seizures

Complex partial seizures are often a lot like sleepwalking. They may involve only some repetitive movements and/or sounds or words, or they may be like full-on, Ambien-fueled sleep-{insert activity here}. Apparently I like to walk around in circles repeating a word or phrase related to whatever I was just talking about. Also hitting something repeatedly, hence breaking stuff.

For more information:

• Simple partial seizures
• Complex partial seizures - Dr. Devinsky’s differential diagnosis of complex partial seizure, absence seizure, and daydreaming is both educational and amusing.³
• Simple partial seizures for neurologists
• Complex partial seizures for neurologists

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2.  Bipolar Disorder

2.1  Bipolar 101

If you don’t know, or have just a vague idea about what bipolar is, here are some good places to start:

• John McManamy’s Bipolar FAQ
• What is Bipolar Disorder? at bipolar.about.com
• Mood Disorder Overview at Depression & Bipolar Support Alliance

2.2  AEDs and Bipolar Disorder

When used to treat bipolar disorder, whether approved or not, most AEDs act as anti-manics. Lamictal (lamotrigine) is the only AED that consistently acts as a true mood stabilizer, i.e. it treats both depression and mania. Depakote (divalproex sodium) - which is approved to treat bipolar mania⁴ - and Keppra (levetiracetam) - which is hardly ever prescribed off-label to treat bipolar disorder - are both known to come down so hard on mania that severe depression is common side effect.

2.3  So, Is Bipolar Disorder a Form of Epilepsy?

No. It’s not. That weird hypothesis has been floating around for a long-ass time. Granted, they have a lot in common, as does depression, which is why AEDs work. And there are plenty of bipolar symptoms due to epileptic events. And more epileptics have mood disorders than non-epileptics. But all that falls under “correlation is not causation.”
The thing is, there’s practically no genetic difference between schizophrenia and bipolar disorder, and antipsychotics (APs) work to varying degrees on both. But lithium and AEDs can only help as add-ons for some schizophrenics and very rarely work alone, while APs as monotherapy will work for many of the bipolar, but sometimes they’re good only as add-ons for some of the bipolar, and sometimes they’re completely useless.

Now let’s approach it from the meds themselves. Glutamate and GABA are neurotransmitters that directly impact seizures, and most AEDs will affect either or both of those. Benzos and Gabitril are all about GABA, but it’s hit-or-miss when it comes to AEDs as mood stabilizers and GABA. Too much dopamine = seizures, and usually, but not always, mania. Too much serotonin = mania, but now they think too little serotonin lowers the seizure threshold, which is why a lot of APs, which are mostly about blocking dopamine, lower your seizure threshold. Except for lithium, which doesn’t affect serotonin and lithium is all about glutamate, unless it’s not, but either way flat-out causes seizures. AEDs affect glutamate indirectly by working on voltage channels. Without a doubt glutamate causes seizures and makes you crazy, but too little serotonin can result in depression or migraines. While a lot of people have both migraines and mood disorders, no one in their right mind would call a migraine a mood disorder⁵.
The meds are what really lets Occam’s Razor rip this hypothesis to shreds. If bipolar disorder were a form of epilepsy:

• Lithium would cause mood swings, not prevent them.
• Antipsychotics would make bipolar worse, not better⁶.
• There would be more AEDs working for more of the bipolar. Pick any AED and you’ll find someone who has managed to control their bipolar symptoms with it. The success rate of that med with epilepsy is going to be a lot higher.

3.  Migraines & Other Headaches

3.1  AEDs with FDA Approval to Treat Migraines

• Depakote (divalproex sodium)
• Tegretol (carbamazepine) - Specifically trigeminal neuralgia and glossopharyngeal neuralgia
• Topamax (topiramate)

3.2  AEDs Used Off-label to Treat Migraines & Other Headaches

• Lamictal (lamotrigine)
• Keppra (levetiracetam)

4.  Neuropathic Pain & Fibromylagia

4.1  AEDs with FDA Approval to Treat Neuropathic Pain & Fibromylagia

• Lyrica (pregabalin)
• Neurontin (gabapentin)
• Tegretol (carbamazepine) - Trigeminal neuralgia and glossopharyngeal neuralgia are technically forms of excruciating neuropathic pain that just happen to be in your head.

4.2  AEDs Used Off-label to Treat Neuropathic Pain & Fibromylagia

Pretty much all of them.

5.  Less Common Off-Label Uses of AEDs

‹ Classifications of AEDs | AED Overview/Topic Index | List of AEDs ›

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Almost all of the material on this site is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, and 2012 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I’m usually cool with it.

All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or 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.
The information on Crazy Meds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else.
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All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away.
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 else we think you should read to help you 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. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
All brand names of the drugs listed in this site are the trademarks of the companies named on the PI/SPC sheet associated with the medication, sometimes on the pages about the drugs, even though those companies may have been acquired by other companies who may or may not be listed in this site by the time you read this. Or the rights to the drug were sold to another company. And any or all of the companies involved may have changed their names.
Crazy Meds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Firefox or Safari, which is what a plurality of visitors use. And I’m running Windows XP3. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazy Meds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazy Meds is not responsible for whatever weird shit your browser does or does not do when you read this site².
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‘Everything is true, nothing is permitted.’ - Jerod Poore

¹ While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

² Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]