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< First-Generation Antipsychotic drugs (FGAs) & Atypical Antipsychotic drugs (AAPs) as Mood Stabilizers | Mood Stabilizer Overview/Topic Index | Bibliography

1.  Using Antiepileptic Drugs (AEDs)/Anticonvulsants (ACs) as Mood Stabilizers

Almost all AEDs/ACs can, and have, been used to treat bipolar disorder, although only Lamictal, Depakote (but not valproic acid), and Equetro (but not Tegretol) have FDA approval to treat bipolar disorder. Stavzor, a delayed release form of valproic acid, has been recently given approval to treat bipolar disorder and migraines. Plus Lamictal (lamotrigine) is the only AC that is a true mood stabilizer and the only one approved for maintenance use (i.e. 18 months instead of 3 to 6 weeks).

2.  Advantages of Using Antiepileptic Drugs/Anticonvulsants as Mood Stabilizers

  • AEDs are proven to be neuroprotective. I.e. they prevent, and even repair the damage caused by bipolar kindling. Lithium is the only AP proven to be neuroprotective for bipolar disorder. As far as I’m concerned this reason alone outweighs all of the disadvantages and makes AEDs and lithium superior to all other APs & AAPs.
  • APs look to be neuroprotective after all. I’m still researching. The evidence for neuroprotection and schizophrenia is strong. I recently found neuroprotection against some of the ravages of chronic alcoholism. I’m probably going to change my mind and come out in favor of AAPs as monotherapy for bipolar disorder.
  • AEDs have been around forever, longer than FGAs1 and way longer than AAPs. As such the effects of long-term use is known.
    • And the long-term use of Lamictal sucks a hell of a lot less than the long-term use of Zyprexa.
  • AEDs frequently work for bipolar disorder at sub-therapeutic dosages (e.g. 100–150mg a day for Lamictal), so any dosage-dependent side effects won’t be as bad.
  • There’s a large overlap in the populations of migraineurs and the bipolar. Around 25% of the bipolar get migraines, while over half of all migraineurs - up to two-thirds of the women - are diagnosed with, or probably have, a mood disorder. And most of them have bipolar 2, whether or not it’s diagnosed or correctly diagnosed. AEDs are really effective for preventing migraines (prophylaxis) and other headaches.

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3.  Disadvantages of Using Antiepileptic Drugs/Anticonvulsants as Mood Stabilizers

  • It mainly comes down to one thing: unpredictability. And when dealing with something like mental health, most people don’t want to deal with any additional randomness, such as:
    • Frequent dosage changes, both increases and decreases.
    • Side effects vary wildly from person to person.
    • Some side effects are dosage-dependent, some aren’t. Sometimes they’ll go away and return. Frequently2.
      • “Dosage-dependent” can mean “you’re not taking enough.”
    • As most3 AEDs act as antimanics you usually need to take an antidepressant as well, so that further complicates the dosage adjustments.
    • No one has a real clue as to how AEDs work as far as bipolar is concerned. They all affect glutamate4, directly or indirectly, and so does lithium. Although the Communications Interference Hypothesis of psychiatric and neurological conditions like depression and bipolar disorder has not been proved or disproved to anyone’s satisfaction, it’s the easiest one to understand. You can understand it, doctors can understand it, you can explain it to other people so they can understand it.5


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< First-Generation Antipsychotic drugs (FGAs) & Atypical Antipsychotic drugs (AAPs) as Mood Stabilizers | Mood Stabilizer Overview/Topic Index | Bibliography

1 OK, lithium was used as a medication long before the first anticonvulsant, but not to treat mental illness. The first effective anticonvulsants - bromides - were used in the 1850s. Potassium bromide is still used today, mostly for critters, and for humans when everything available has failed, usually in developing countries. In the 1910s the barbiturates were developed, some of which (phenobarbital, e.g.) are still used to treat epilepsy. In the 1930s we got the hydantoins, the best of which, phenytoin, is still a first-line medication in some parts of the world, and a second-line med for some forms of epilepsy in the industrial west.
Lithium wasn't used for brain cooties until about 100 years after the bromides were used for epilepsy.
Then again, the world's first antipsychotic, with documented indications, effects and side effects exactly the same as early FGAs like Thorazine, is Rauwolfia serpentina, which has been continuously used in Ayurvedic medicine for over 3,000 years. The first modern antipsychotic, reserpine, was originally derived from it in India in the 1930s. Reserpine is mainly used today as a third-line hypertension medicine, but is still approved as an antipsychotic.

2 Such frustrating unpredictability and randomness is the real reason this site is called Crazymeds. It's not what the drugs are used for, it's the way they act that makes them crazy.

3 I.e. all of them except Lamictal (lamotrigine). At first anyway. Usually. See what I mean about unpredictable?

4 The AEDs that actually work for bipolar disorder affect glutamate. Gabitril and Sabril (vigabatrin) are almost pure GABAergic drugs and fairly useless as far as BP is concerned. How Neurontin (gabapentin) and Lyrica (pregablin) work keeps changing, but glutamate either isn't in the picture or isn't affected enough to deal with BP. Keppra is also mysterious, but it might hit glutamate eventually as Keppra is a pretty good (often way too good) antimanic.

5 Except for those who choose to be willfully ignorant. There's nothing you can do about those fucktards other than avoid them as best you can.

6 Thanks to all of the lab rats who were given seizures via electroshock, lithium, or genetic engineering, then treated with various AEDs, all while having their brains exposed, probed, and eventually sliced up. And humans having seizures in MRI tubes, during EEGs and SPECT scans, then taking meds and undergoing seizurogenic stimuli to see how stuff works. Science!
Tell me PETA, which sucks less, someone's baby slowly dying of West syndrome, or a hundred lab rats getting lithium and vigabatrin cocktails?

Antiepileptic Drugs/Anticonvulsants as Mood Stabilizers is copyright 2011 Jerod Poore
Page created by: Jerod Poore. Date created: 26 January 2011 Last edited by: JerodPoore on 2016–04–18

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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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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.
Crazymeds now uses a secure server, but it is not so secure that you can discuss anything having to do with nuclear power facilities, air traffic control systems, aircraft navigation systems, weapons control systems, or any other system requiring failsafe operation whose failure could lead to injury, death or environmental damage. Just so you know. So if you’re mentally interesting and have a job that deals with that sort of thing, talk about said job elsewhere. Otherwise feel free to discuss your meds and brain cooties.
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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.

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