Anticonvulsants - The Good, The Bad and The Funny. From People Who Have Taken These Crazy Meds...and SCIENCE!

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Basic Information About Anticonvulsants / Old School Mood Stabilizers.

Anticonvulsants are broken up into different classes based upon chemical structure, how they work in your brain or how your liver deals with them. Brain, liver, they're all squishy bits, right?

So in the US market we have the valproates:

Depakote (divalproex sodium)
Depakene (valproic acid),
and the rarely used (but much more popular overseas) Depacon (valproate sodium or sodium valproate depending on the literature you read).

Look closely, note that valproic acid is not the generic for Depakote. I'll be hammering this point until people get it. These three meds are very closely related chemically, and are often lumped together as the same med. But they aren't really. Once they hit your brain it's close enough for government work, but in your digestive system and liver they can be very different. If circumstances force you to switch from one to another your brain won't care too much, but your digestive system might care, and let you know in no uncertain terms.

Next up are the Enzyme Inducing Anti-Epileptic Drugs, or EIAEDs. A barely-related family of meds that produce similar effects on your liver, and wildly different results in your brain. They are grouped together though because of important drug-drug interactions with other meds, including other anticonvulsants, antidepressants, antipsychotics, as well as other, non-crazy medications. It does make sense to group these together because AEDs have what is known as a "narrow therapeutic range." I.e. a slight change in how much how much you have in your system can cause you to lose seizure control. It's also why neurologists were the first doctors to recognize the difference in brand vs. generic medications. The drugs in this family include:

Dilantin (phenytoin)
phenobarbital
Tegretol / Carbatrol (carbamazepine)
Trileptal (oxcarbazepine)

Only the last two work in similar ways in your brain and are chemically related. See the pages for more detail, but you can pretty much switch between Tegretol and Trileptal without too much trouble. Dilantin is also classed as a Hydantoin, along with Cerebyx (something you'd only get in a hospital). As of this writing there are new medications, some under development, some waiting for FDA approval to be released, that are variations of Tregretol and Dilantin. I don't know if they'll induce enzymes or not.

Then there are the GABA analogues. These meds are basically fake GABA, a neurotransmitter critical to treating epilepsy, bipolar disorder, anxiety disorder and a variety of other issues. Real GABA can't cross the blood-brain barrier, so don't waste your money on buying GABA at the health food store. Gabitril isn't really a GABA analogue, but it gets classified as such because all it does is potent GABA reuptake inhibition and absolutely nothing else. No voltage channel modification, no messing with glutamate or kainate. Nothing. So it may as well be fake GABA because you get slammed with enough of it when you take some. Trust me on that point.

Neurontin (gabapentin)
Gabitril (tiagabine)

Technically the benzodiazepines are also anticonvulsants, and while they have their place in treating both epilepsy and bipolar disorder, they have a section of their own.

A couple meds we may or may not cover are the Succinimides - Celontin and Zarontin. These are kind of last resort meds for absence and partial seizures. I've not been able to find out too much about them. One of these days I'd like to cover them.

That leaves all the other anticonvulsants:

Felbatol (felbamate)
Lyrica (pregablin)
Keppra (levetiracetam)
Lamictal (lamotrigine)
Mysoline (primodone) (withdrawn from most markets, good luck finding it)
Topamax (topiramate)
Zonegran (zonisamide)

Again, to get technical, Lamictal is in a class of its own. Which shouldn't surprise anyone. It's a Phenyltriazine.

At some point I hope to cover some of the meds only available or primarily used outside of the US. Such as:

Diamox (acetazolamide)
piracetam
Sabril (vigabatrin)

Then we have the stuff has anticonvulsant properties, but the use of which is way off-label. For example:

Meclofenamic acid, a non-steroid anti-inflammatory that is regularly used to treat canine epilepsy. It is approved as a human painkiller, so this isn't a vet drug.
Progesterone-based birth control pills. Sorry, guys, this is just for the girls. This is both for Catamenial epilepsy (shaking it up that time of the month) and all other forms. I've found a couple of studies in humans (and plenty in critters) that show progesterone to have mild anticonvulsant properties in of itself or as an add-on to other meds. One from Finland and one from the good old USA. This doesn't even count its use in treating catamenial epilepsy, which is documented all over the place.

People are constantly asking me what the equivalents are for different anticonvulsants. Except for Tegretol / Carbatrol (carbamazepine) and Trileptal (oxcarbazepine) or all of the valproates (Depakote (divalproex sodium),Depakene (valproic acid) and Depacon (valproate sodium)) it literally is an apples and oranges comparison. But since apples and oranges are both types of fruits, there are commonalities. Brent Jensen of Queen's University School of Medicine, Kingston Ontario has put together a handy Mood Stabilizer Comparison Chart. Of course it applies only for meds available in Canada, eh. And it deals with these medications only as they apply to treat bipolar disorder, and not epilepsy, migraines or any off-label applications. But it's better than nothing. Especially until I get around to doing the drug-to-drug comparisons for anticonvulsants like I have for some of the atypical antipsychotics like Seroquel (quetiapine).

Click on the following to learn more about anticonvulsants:

Basic Information About Anticonvulsants Typical Uses of Anticonvulsants Common Side Effects SUDEP (Sudden Unexpected Death in EPilepsy) and status epilepticus Taking and Discontinuing Anticonvulsants

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Take care, 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.

Dead tree references:

End of books used for this article.

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Created Monday, November 15, 2003

Last updated Saturday, May 15, 2010

Almost all of the material on this site is copyright © 2003 - 2009 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 cool with it.

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.

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