Dosages, Taking and/or Discontinuing Anticonvulsants / Mood Stabilizers - The Good, The Bad and The Funny. From People Who Have Taken These Crazy Meds...and SCIENCE!

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Tips about Dosages, Discontinuing, and Just Taking Anticonvulsants / Mood Stabilizers

Some tips that are general to all anticonvulsants / mood stabilizers regarding their dosages, discontinuation, and just taking them. You'll have to look up the pages on the individual meds for more specific information.

The dosages and titration for the anticonvulsants are typically identical for epilepsy and bipolar, so if you are blessed with the dual diagnoses of bipolar and epilepsy as I am, treat the epilepsy first. Find a med that will get the seizures under control and you'll find that the bipolar won't be as bad. The odds are that strategy won't get the mood swings totally under control, but they will likely be mellower. This is complicated by complex partial seizures mimicking bipolar symptoms. Hey, I tried to explain to everyone when I was sent to the lock ward in the summer of 2004 that I was having seizure problems, not bipolar problems, but they see that bipolar history and it's 5150 time for such behavior.

You may be wallowing in depression, but believe us, as much as depression sucks it is far less dangerous and damaging than mania or the especially sucky mixed state. Once the seizure activity is under control, then start going after the bipolar, using the anticonvulsant(s) you're on as a baseline for your treatment of bipolar. Try to get your neurologist and psychiatrist talking to each other from the beginning.

Actually, there is an exception to the dosage of anticonvulsants being identical for epilepsy and bipolar. In extreme cases of epilepsy the drugs are often rated for a slightly higher dose for really severe seizures. But those dosages are not meant for long-term usage. They're just to get the seizures under control until you can find an add-on medication or another med all together.

My general rule for taking mood stabilizers of all flavors and using anticonvulsants for anything except controlling seizures is to start at a low dosage and slowly work your way up until your symptoms are under control. Then hold there. Really, it's that simple. For some people that means you'll be at what is normally a sub-therapeutic dosage. I was fine at 175mg a day of Topamax (topiramate) for over a year. Lots of people are quite happy at 100mg a day, or less, of Lamictal (lamotrigine) for unipolar or bipolar depression. Sure, eventually those dosages may need to go up. I'm now at 225mg a day of Topamax, and have been there for some time. Maybe I need more now. Maybe not. Some people eventually need more Lamictal, some don't. That's the beauty of these meds, you can make do with low dosages for a long time for a lot of disorders.

But when it comes to epilepsy, you take whatever the hell your neurologist tells you to take. Don't argue.
The evidence is piling up that many of these meds can suppress or even reverse the kindling damage to the brain that epilepsy, and presumably bipolar disorder, can do to the brain. Keppra (levetiracetam) is one med shown to do it in humans. Gabitril (tiagabine) is another that has worked in humans, but for people whose brains have really kindled. Still, it would likely work for everyone else. Lamictal (lamotrigine) has tested well in rats. Topamax (topiramate) has done so as well.

What does that all mean, all that stuff about suppressing and reversing kindling damage? It means that long-term use of anticonvulsants actually repair your brain. Isn't that frickin' miraculous? Now this will take years, folks. Not weeks, not months, but years. It's slow, complicated work on the most complicated organ in your body. The bit that is most responsible in defining just who you are. But the meds are doing something that radical brain surgery is only sometimes able to do. With a lot less blood, and far less chance of your dying or walking around with one foot dragging behind you and not being able to remember the names of any fruits.

It also means that after so many years you can probably start lowering your dosage to a nice maintenance dosage of whichever anticonvulsant you get along with best. So if you're on a cocktail of a bunch of meds now, eventually you can look forward to being on one or two.

If you've been taking anticonvulsants for a few months or longer and need to stop, you can't stop cold turkey. Unlike stopping SSRIs the effects of sudden discontinuation aren't just viciously unpleasant, they can be downright dangerous. You run the risk of having seizures on top of bipolar, migraines or whatever getting worse. These run the gamut from partial complex or absence seizures to tonic-clonic grand mals. Maybe you'll have this problem, maybe you won't, there's no way to tell. If you never had a seizure before that doesn't mean you won't start flopping around like a fish out of water. The risk is worse if you're taking a lithium variant, and/or any antidepressant, especially Wellbutrin (bupropion hydrochloride).

Anticonvulsants need to be gradually discontinued to prevent any seizure activity from happening. With gradual discontinuation the worst most people experience is slight dizziness, confusion and sensitivity to sound and/or light. If you're already taking another anticonvulsant and are in the therapeutic range already, then you can probably stop one cold turkey with little risk of seizures, presuming you have no past history of seizure activity. You'll feel other wacky effects, and those will vary from med to med, but you won't be risking seizures. Let me qualify that, it has to be an anticonvulsant that is known to be effective for you. If it's a new anticonvulsant, well, you just never know. The odds are in your favor at least.

If you do have a history of seizure activity, stopping any anticonvulsant cold turkey is never a decision you should make based upon information gleaned from any stupid website on the goddamn Internet you jackass, you should be discussing that with at least two neurologists! Get off your computer, on the telephone and start making appointments!

If you are stopping, there had better be a good reason. Is it because the drug isn't working as well as it did before? If that's the case it may be a question of just adjusting the dosage - upwards or downwards. Gabitril (tiagabine hydrochloride) is the one anticonvulsant I know of that will poop-out with any regularity. Anecdotal evidence of users (as well as my own experience) has it pooping out for various off-label psychiatric uses all the time. For epilepsy the data are contradictory. One review of case histories (plus bunches of individual case reports) makes it look kind of dodgy. Another clears it. In any event, all the others rarely do fail on their own accord. If you haven't been 100% compliant with taking your meds like you're supposed to, well, don't go blaming the med.

What happens with them, though, is you'll often have breakthrough symptoms of whatever you're taking an anticonvulsant for and you'll need to have your dosage and/or your dose schedule adjusted. Try that before just giving up on a particular anticonvulsant.
Because anticonvulsants are so freaking picky you have to be 100% compliant about taking your meds every day, when you're supposed to. If you're supposed to take them with food, then take them with food. It'll help to keep a journal of effects if you eat a particularly varied diet, because different foods can mess with the absorption rates of different meds. Tegretol (carbamezepine), for example, does especially well when taken with fatty foods.
Once you find the right anticonvulsants, and the right dosages, however long that may take, after 3-12 months you'll find yourself thinking really clearly. Whether it's for bipolar, or epilepsy or both, you'll just be thinking clearly. Unless you're just taking Keppra (levetiracetam), in which case you'll probably be thinking way more clearly than ever in a matter of days. You'll need some patience, obviously. You have to get beyond the quick-fix mentality that too many people have. What's a year compared to the rest of your life?

Just think how miraculous it is. These little pills (OK, if you're taking a valproate they're big-ass pills) are changing the way your brain works. Without surgery. No more seizures. No more mood swings. No more migraines or PTSD flashbacks or whatever. To me that is truly a miracle of modern science! Think how long it would take to recover from an auto accident where your car is totaled and they cut you out of the wreckage with the jaws of life and you had casts and metal pins and everything. Well with bipolar disorder and epilepsy it's just like that. A car-wreck in your head. Have some patience with how long it will take and give yourself some space to heal.

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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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.

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Created Sunday, January 30, 2005

Last updated Wednesday, February 03, 2010

Almost all of the material on this site is copyright © 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009 and 2010 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.

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"Everything is true, nothing is permitted." - Jerod Poore