< Tips on Taking or Discontinuing Antiepileptic Drugs | AED Page List/Topic Index | Bibliography

There are side effects common to all antiepileptic drugs (AEDs) / anticonvulsants (ACs). As many of these side effects overlap with various antipsychotics (APs) used as mood stabilizers (lithium, and atypical antipsychotics (AAPs) like Seroquel e.g.), some of those meds will be mentioned in passing for members of our bipolar audience.

Here are the most prevalent, notable, or ones you really have to watch out for:

1.  Don’t Be it, Dream it.

As with all crazy meds, 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). This may be a temporary side effect, or it may last as long as you’re taking the med, and perhaps for days or even weeks after you stop taking it.

When I started taking Topamax (topiramate) my dreams changed to being a replay of what I did each day. The sequence was usually different, but what little I did each day was played out again each night for about a year. It was almost like watching the world’s most boring TV channel, except most of my dreams are from a first-person perspective and are a full sensory experience in that I also feel and smell everything I interact with, and will even feel the physical sensations of things like depression and panic. It was really disorienting those times when it was 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.
While all crazy meds can, and often will alter your dreams in some fashion, nothing messes with your dreams like some form of antipsychotic or anticonvulsant.

2.  Get Used to the Vampire Lifestyle

No more getting up early, going outside and getting all tanned once undergoing treatment with any AED, lithium, and many antipsychotics (APs), particularly atypical antipsychotics (AAPs), as you’ll want to sleep more and must avoid prolonged exposure to strong sunlight. Some are worse than others, Tegretol (carbamazepine USP) and Trileptal (oxcarbazepine) are the worst offenders, but since so many of us in the bipolar and epileptic spectra go Goth, or adopt a similar nocturnal lifestyle involving cigarettes and solitude, it seems a pointless warning.
This side effect tends to last for as long as you’re taking the med.

3.  Just Five More Minutes, Then I’ll Get Up

Lethargy is especially bad with many AEDs, lithium, and most APs. Fortunately it gets somewhat better with time. The very nature of these medications is that they slow down your brain to fight your mania (and positive symptoms for the schizophrenic), or to prevent you from having seizures.
With epilepsy you wind up slower than a normal person is. With Bipolar 1 you usually end up slightly slower than a ‘normal’ person is after being used to being ‘better’ (thinking faster, not needing as much sleep, etc.) 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 forums 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 and talk about it with a support group (which is not here).
General lethargy, feeling tired and run down all the time, etc. usually goes away after a couple of months and is dosage-dependent (you might be taking too much if you’re really tired all the time after 4–5 months). That also depends on any other meds you might be taking. Lethargy is also a symptom of folate deficiency, so take a look at the section on folic acid.
No matter what, if you’re used to sleeping an average of 5–8 hours a night (if that much), get used to needing 7–9 hours a night, if not more for the first few weeks. In the long run 7–8 hours of sleep is a lot better for your mental health than 5–6 hours a night1.

4.  “…and it can’t make me fat.”

Anticonvulsants have a reputation for weight gain, which is untrue. Of all the FDA-approved AEDs, weight gain is a common side effect only with the valproates (Depakote (divalproex sodium), Depakene & Stavzor(valproic acid), and whatever they call sodium valproate / valproate sodium where you live), and usually at the higher dosages. It’s uncommon-to-rare with all the others. Many of the other drugs used as mood stabilizers - lithium and other antipsychotics, especially atypical antipsychotics, are far more likely to cause weight gain. AEDs are being hit with guilt by association.



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5.  Wait. It’s on the Tip of My Tongue.

Almost all AEDs will seriously mess with your memory and cognitive processes - at first. Topamax (topiramate) and Zonegran (zonisamide) are by far the worst offenders in this category2, with Tegretol and Trileptal not all that far behind. Keppra (levetiracetam) is the only AED (that we know of and as of this writing) that doesn’t negatively affect memory and thinking that much, if at all, for most people who take it.
The “which sucks less” math is really easy to do here. The kindling of uncontrolled seizures and/or bipolar mood swings will fry your brain. If those aren’t controlled you’ll get as stupid as a huffer. If you’re bipolar, apply the phrase “It seemed like a good idea at the time,” to the craziest shit you’ve done when manic. Now which seems less stupid, sounding like the village idiot, or doing whatever it was you did?
It’s hard to tell how long this side effect will last. With some, like Tegretol and Trileptal, it’s usually time-dependent. With others, like Depakote and Neurontin, it’s mostly dosage-dependent in that if the stupids don’t go away after a few weeks you’re probably taking too much. With others, especially Topamax, it’s dosage dependent in that you need to be at just the right dosage or dosage range, and you may need to adjust the dosage. Which means taking too little Topamax could be making you stupid as hell.

6.  I Thought Folic Acid was Just for Pregnant Women

All AEDs deplete you of folic acid to some extent. Which means you should take a folic acid supplement, right? Sure, but not too much folic acid, because according to at least one double-blind study3 patients taking more than 1,000mcg of folic acid along with their Depakene (valproic acid) started experiencing increased seizure activity. It was once thought that being a folate antagonist was how some AEDs worked to control seizures, and Lamictal (lamotrigine) was originally developed as a folic acid antagonist to test that hypothesis. It turned out to be only a weak folic acid antagonist4 and most of the recent studies have disproved the connection between all but excessively high levels of folic acid and seizures. Still, play it safe, unless a doctor tells you otherwise, take no more than 1,000mcg in folic acid a day in the form of supplements. I take Lamictal and Topamax and 400mcg of folic acid a day is plenty for me.
It’s not just folate. AEDs also deplete you of vitamin D, although it’s not as cut and dry as folic acid. The enzyme-inducing AEDs, especially Tegretol (carbamazepine USP) and Dilantin (phenytoin) are the worst - but factor in the photosensitivity and you should probably take a vitamin D supplement as well. Again, talk to your doctor.

7.  Female Trouble

Almost all AEDs (the one exception, so far, is Lamictal (lamotrigine)) mess around with girly hormones, just to varying degrees. You can expect things like menstrual cycles being disrupted, or positive benefits like PMS or PMDD symptoms being lessened. If you’re taking birth control pills you and your OB-GYN (or whoever prescribed them) must discuss the interaction of these meds with The Pill, as you may need a stronger pill, a weaker pill, progesterone-based birth control, or you may have to ditch hormonal birth control entirely and use something else. The enzyme-inducing AEDs, especially Tegretol (carbamazepine USP) and Dilantin (phenytoin) are the worst when it comes to affecting The Pill and even your own girly hormones.

PMS and PMDD symptoms can just as easily be worsened as they can be improved.

Estrogen-based birth control interferes with Lamictal (lamotrigine). In rare cases how quickly Lamictal is cleared from your system, to the point of changing how effective it is, can be influenced your own monthly cycle.

8.  One for the Road

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.
Not drinking at all is probably the best course of action. More AEDs are coming with warnings not to drink alcohol when taking them (e.g. Topamax), and mixing booze and APs is insanely stupid not as bad as I thought it was, but still not a good idea to do very often, or in great amounts.

9.  I’ve Got an Itch I Can’t Scratch

Anticonvulsants are rash medications. No, they won’t make you go out and do stupid things without thinking about it first. Usually. 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.
Now if you get either hives or you get an itchy 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.
For some people these side effects eventually go away, for others, get used to buying lots of ointments and lotions.
This page has a breakdown of different rashes you can expect from some especially itchy AEDs. Bonus: gross pictures.



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10.  Four out of Five Dentists Recommend…

Not only do AEDs 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. It’s probably due to the lack of vitamin D (see above).
This side effect tends to be permanent, and sticks around for some time if you stop taking AEDs.

11.  It’s Eating my Blood!

All AEDs carry the risk of aplastic anemia and agranulocytosis. In plain English they’ll screw up your red blood cells and white blood cells respectively, and those are just two of the blood dyscrasias (an imbalance of one or more components) you can get. Tegretol (carbamazepine USP) carries the greatest risk for agranulocytosis, and it is recommended you have regular blood work for it.
These are rare, but still real and potentially deadly risks. While listed in the PI sheets for most crazy meds, and a lot of other prescription and non-prescription drugs as well, and even happens to people who aren’t taking any medication of any kind, the chances of it happening to anyone taking an AED (and a couple of APs) are less extremely rare enough to be listed as a warning.
So if you suddenly have any weird bruising that you can’t explain (the aplastic anemia), or fever and constant infections (agranulocytosis), you need to deal with that immediately. As in seeing any doctor or nurse practitioner today (or whenever you notice the symptoms).
Once something like this happens, you can’t take that med anymore. Ever.

12.  “…and I don’t want to be bald, either!”

And to cap it off, AEDs mess with your hair. Depakote and lithium are the worst when it comes to hair interaction, but all AEDs can change the nature of your crowning glory. Hair thinning is the most popular side effect, but they and other anticonvulsants and some APs 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 crazy meds, especially AEDs, damn near anything is possible.
This is yet another side effect where you won’t know if it’s temporary until it stops.



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1 One more argument for getting treatment sooner than later: if you do become treatment-resistant because you kept resisting getting proper, and consistent treatment for a long time, as I did, you'll wind up on a cocktail of several meds just to get partial control of your symptoms. Taking several meds every day often results in sleeping 9 to 11 hours a night. Permanently. I sleep 9 hours a night in the summer and 10-11 hours a night in the winter. I've read of people sleeping longer, but only for short periods of time. 11 hours seems to be the top end of how long anyone taking a lot of meds needs to sleep on a regular basis.

2 Topamax and Zonegran not only make you stupid, they also make you skinny; hence my coining the term "supermodel drugs" to describe them.

3 The Lancet 1967 1:1086 Reynolds, EH "Effects of folic acid on the mental state and fit frequency of drug treated epileptic patients."

4 Like how Topamax was originally developed as a med to control glycemic response and weight gain in people with type 2 diabetes.


Common Side Effects of Antiepileptic Drugs / Anticonvulsants by Jerod Poore is copyright © 2010
Page created by: Jerod Poore. Date created: 21 November 2010 Last edited by: JerodPoore on 2016–05–08





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Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still 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 medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList, NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. 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 medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
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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.
Crazymeds is optimized for ridiculously large screens and browsers that don’t block ads. I use Firefox and Chrome, running under Windows 72. 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, Crazymeds 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 Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
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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 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

Author: Date Modified: 2016–09–28 Date Published:

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