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

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Uses for Anticonvulsants / Mood Stabilizers

In Bipolarland the term "mood stabilizer" incorrectly applies to anticonvulsants only. In fact the set of medications that act as mood stabilizers includes anticonvulsants, antipsychotics and lithium. Anticonvulsants include benzodiazepines, which also have anxiolytic (anti-anxiety) properties. Antipsychotics are broken up into two classes, the older typical and newer atypical classes, and they also deal with a variety of other psychiatric issues. Confused yet? It's no wonder that drugs are just thrown at patients until something works, there are so many from which to choose! When you total them up there are over forty, that's right, more than 40 medications that act as mood stabilizers, although officially just a handful have FDA approval for such.

Most mood stabilizers are really anti-manics. Sure, they'll take the edge off of bipolar depression, but what they're really good at is bringing you down from your manias. Sometimes too far down. Only lithium and Lamictal (lamotrigine), amongst the officially approved treatments for bipolar disorder, are known for helping with bipolar depression. Along with the antipsychotics Geodon (ziprasidone) and Abilify (aripiprazole). Sometimes Geodon (ziprasidone) and Abilify (aripiprazole) can be a little too good at bringing the bipolar up from the depressed depths. Some word is coming up about the anticonvulsant Zonegran (zonisamide) being good for depression as well, although I'm a bit leery of Zonegran (zonisamide) in general.

All anticonvulsants try to calm hyperactivity in the brain, and this works for epilepsy and bipolar equally. How they go about it will vary from med to med. They target different areas of the brain. They all work with some neurotransmitter or another. Most deal with a voltage channel or two. A few deal with some other things as well. When dealing with epilepsy a good neurologist will be dealing with your symptoms and EEGs and selecting the best meds to try first. Bipolar disorder should work the same way, but far fewer psychiatrists work that way, so I'll be touching upon it in articles on which meds are likely to be best for you. Anticonvulsants work on the brain in unique and often little-understood ways that they are now being evaluated for a wide spectrum of disorders beyond the traditional ones of epilepsy, bipolar and migraines, including the less common forms of PMDD.

Different anticonvulsants are generally more effective for different forms of bipolar, epilepsy and migraines. These are addressed in detail in the articles for individual meds, in future articles that will be about specific disorders, and the eventual Crazy Meds' Drug Algorithms. For now, here's the short version of the first medication to try for specific diagnoses:

Bipolar 1: lithium
Bipolar 2: Lamictal (lamotrigine)
Bipolar with rapid cycling (four times a year to four times a month) to ultra-rapid cycling (once a week to once a day) features and/or mixed states: Depakote (divalproex sodium) if primarily manic or mixed. Lamictal (lamotrigine) if primarily depressed with or without mixed states. Usually with an atypical antipsychotic.
Bipolar with ultradian rapid cycling (cycling several times a day): Depakote (divalproex sodium), Topamax (topiramate)or a cocktail of Lamictal (lamotrigine) and one of: Trileptal (oxcarbazepine), Tegretol (carbamazepine USP) or Topamax (topiramate). Usually with an atypical antipsychotic.
Bipolar 6 or NOS with periods of totally over-the-top euphoric mania: Keppra (levetiracetam). Good for seasonal manias.
Generalized, full-on tonic-clonic (or clonic-tonic as the case may be) seizures: Topamax (topiramate)or Depakote (divalproex sodium).
Temporal lobe epilepsy (TLE): One or more of: Trileptal (oxcarbazepine), Tegretol (carbamazepine USP) or Topamax (topiramate). Lamictal (lamotrigine) is also showing promise for TLE.
Frontal lobe epilepsy: Lamictal (lamotrigine) or Dilantin (phenytonin)
Hippocampus-based epilepsy or other stuff with weird-ass symptoms they can't pin down: Keppra (levetiracetam). Sometimes Lamictal (lamotrigine). Sometimes either of those mixed with Topamax (topiramate).
Lennox-Gastaut syndrome: Lamictal (lamotrigine) and/or Topamax (topiramate).

There are a bazillion forms a epilepsy. Those are just off of the top of my head. Wait for the full article, and don't but me about writing it. Bugging me about writing it will just delay its publication.

As for migraines, I don't know enough about them. Sorry, I just suck that way. Maybe one day I'll be useful in that area.

There's a wacky hypothesis floating around, one that is not my own for once, that some forms of bipolar and migraines are really subsets of epilepsy, so that's why every anticonvulsant on the market doubles as a mood stabilizer and potential migraine medication. As soon as a new one hits the market, it gets evaluated for bipolar and migraines, even though currently only Depakote (divalproex sodium), Tegretol (carbamazepine USP) and Lamictal (lamotrigine) are the only anticonvulsants with official FDA approval to treat bipolar. While Depakote (divalproex sodium) and Tegretol (carbamazepine USP) and Topamax (topiramate)have the official nod to treat migraines. But there's plenty of off-label prescribing going on, and I'm all for it in most cases (details of which are covered on the individual med pages).

That hypothesis load of crap, as witnessed by the short-term effectiveness of antipsychotics as mood stabilizers. Most telling is this study. If nobody having a psychotic episode is going to show any epileptiform activity on their EEG, then it's pretty much a given that bipolar disorder, schizophrenia & schizoaffective disorder don't live in the epilepsy spectrum. Even if 12% of people with epilepsy have bipolar disorder. We sort of make life hell for both neurologists and psychiatrists, and they seem to wish that we didn't exist, even if anticonvulsants do double duty. Probably because one anticonvulsant just won't cut it for all of our issues. Oh, and let's further confuse the issue with the fact that symptoms of some forms of epilepsy mimic those vary psychoses, enough to confuse the hell out of numerous shrinks. I've had two psychiatrists suggest that I'm not bipolar at all, that it's all an epilepsy thing. On the flip side, when I spent 72 hours in a psychiatric lock ward, it was because I was suffering from long bouts of complex partial seizures.

My mind is still open about migraines being a form of epilepsy. There are still enough similarities between the actual disorders, and not just the treatments, for me to accept that a migraine is one hell of a long-lasting seizure with godawful pain thrown in for good measure.

The reason why anticonvulsants seem to work for bipolar disorder (and other things) is explained here. At least it was as of this writing. If that link vanishes I'll try to write it up myself sometime. The short answer: For the same reasons why ECT, Vagus Nerve Stimulation and Transcranial Magnetic Stimulation all work - messing with voltage channels helps to regulate errant signal processing.

Besides epilepsy, bipolar disorder and migraines, what else are anticonvulsants used for?

A variety of neuropathic pain treatments. If it hurts and they think the source of the pain is in your head (not that you're imagining the pain, but that the cause of the pain is from a brain malfunction), anticonvulsants are a first-line treatment. Neurontin (gabapentin) is especially popular for this, being approved for one form of neuropathic pain and having one of the lower side effect profiles around. Some examples:

Other types of headaches besides migraines. Such as:

Lamictal for SUNCT syndrome headaches
Topamax for cluster headaches (not a first-line treatment)

Anticonvulsants aren't usually first-line meds with anxiety disorders. But there are some forms that respond better to anticonvulsants than other meds. The type of anxiety that cycles is one example. PTSD is another. And if OCD doesn't respond to anything else, an anticonvulsant can sometimes boost the effectiveness of an SSRI. For instance:

As you'll see from the side effects page, anticonvulsants make you sleepy. Eventually they'll go from making you tired all day to making you sleep 8-9 hours a night. Deal with it. In any event this makes them excellent meds for sleep disorders! So we have:

Just as atypical antipsychotics are frequently used to treat bipolar disorder, anticonvulsants are now on the leading edge of research into the treatment of schizophrenia and schizoaffective disorder. Cases in point:

Another difficult to treat illness is borderline personality disorder. Anticonvulsants have shown promise in treating a variety of elements of BPD:

Alcoholism and other substance abuse issues. And not because someone was just trying to self-medicate their way out of bipolar disorder either. For some reason anticonvulsants are just good at helping people with their substance abuse issues. Some examples of this include:

It's almost like there's not a form of mental wackiness that some anticonvulsants hasn't been used to treat! I'm still working on all the pages for them, but just use the search feature in the table of contents to search this site if you're looking for a particular disorder, and chances are you'll hit one or more references to anticonvulsant pages.

If it's bad enough where you need to take an anticonvulsant / mood stabilizer, there's usually no question that you need to be taking meds. Really. If your doctor says you need to be taking one of these meds, then you are fucked up enough to need to be taking one of these meds. It's really that simple. Stop denying whatever the hell it is you've been denying. The only thing I require of the doctors is that they do a thorough examination of someone before prescribing any medication. A fifteen minute diagnosis is rarely enough, unless someone is obviously flipping out.

Plus you need to be seeing a therapist or a counselor. If you're nuts, you need to see a therapist, and that's that. The meds are just not enough. If you're epileptic, have some other seizure disorder, have migraines or other type of neuropathic pain, or are taking these crazy meds for any of the vast array of off-label uses, you should see a counselor to get a better idea of how you need to live your life with whatever disorder you have, because your doctor sure as hell isn't going to tell you everything you need to know. And regardless of the affliction, you need to belong to a support group to learn what it's really all about to have whatever you have. For more information on, and reasons why you should be seeing a pro and belong to a support group, take a look at my page on support groups.

Despite all the scary potential side effects, it really is better to try some form of anticonvulsant / mood stabilizer once you have a diagnosis of bipolar disorder, be it one or more of lithium, an anticonvulsant or an antipsychotic. The same applies to epilepsy and anticonvulsants. Just letting it, or them go brings the kindling effect into play, where every mood swing or seizure just gets your brain into that much worse of shape and makes it that much harder for the anticonvulsants or other mood stabilizers to work if and when you decide to eventually start trying them. The bipolar are amongst the worse to seek treatment, so it's not just you, it's hard for all of us, and the combination of nasty side effects and there being no guarantee of any single medication working doesn't help matters any. Yes, you may have to try several medications or combinations of medications before you find something that works, but the odds are there is a drug or combination of drugs that will work for you. And if you have one of the many other disorders that anticonvulsants are being applied to - depression, PTSD, anxiety, alcoholism and other drug addictions, various psychotic symptoms and you don't get along with any antipsychotics, whatever; if your doctor recommends an anticonvulsant, do the research and make an informed decision. But my advice is to at least give a couple of the meds in the class a try. They are weird and they are picky, but when they do work they can turn your life around. Unfortunately a few people have started to jump on the anti-anticonvulsant bandwagon. It started with a report by Dateline on Parke-Davis' truly sleazy marketing of Neurontin (gabapentin) . While Neurontin (gabapentin) can be a useful medication for a variety of disorders beside epilepsy, Parke-Davis went way over the top in getting that point across to doctors. Now it's up to a jury to decide just how bad they were. However, that report has led to fear-mongering articles such as this where only epilepsy is deemed serious enough to risk the potential side effects of Topamax (topiramate), and that conditions such as bipolar disorder just aren't severe enough. And of course the study on anticonvulsants and bipolar patients using Topamax (topiramate)quoted in the article, did it screen for people with temporal lobe dysfunction as part of their bipolar, you know, the people for whom Topamax (topiramate)does the most good? I thought not. Oh and the glaucoma associated with Topamax (topiramate)? It goes away when you stop taking Topamax (topiramate). Isn't that worth risking to relieve migraines?

Anyway, now many people are stating that it should be lithium only for bipolar. Guess what folks? Lithium was even an off-label drug for bipolar. It was originally prescribed for uraemia, renal calculi, gout and rheumaticism, and later hysteria. If we didn't use anything off-label, we'd have precisely zero, that's 0 medications for bipolar disorder. But it should be a serious disorder to take anticonvulsants, as is true with any neurological / psychiatric medication. Vanity weight loss is no reason to take Topamax (topiramate)or Zonegran (zonisamide). Anxiety disorders or depression that may respond to therapy alone are no reason to take Gabitril (tiagabine hydrochloride) or Lamictal (lamotrigine). These things suck, but do they really suck badly enough to put up with these crazy meds? That's the sort of thing that you and your doctor have to take the time to figure out, and not just throw a med at a problem after a haphazard 15 minute appointment. I'm all for the appropriate use of medications, even appropriate off-label prescriptions. But it has to be done the right way, dammit.

In fact, even for all the wacky off-label stuff, anticonvulsants are probably worth a try if the regular medications don't do it for you. As the above mentioned article notes, they are being tried for just about everything. They are weird, weird meds and they work in mysterious ways, but they do work. OK, Neurontin (gabapentin) and Gabitril (tiagabine hydrochloride) are notorious for not working. Neurontin (gabapentin), while it works for me, has a high failure rate because it doesn't get digested well by a lot of people. Its successor med Lyrica (pregablin) is supposed to address these issues. We'll just have to see about that. And Gabitril (tiagabine hydrochloride) is the one anticonvulsant that will poop-out with any regularity when used for psychiatric disorders. But all the others, they certainly do something. They may not be the answer for you, but you will note that they will change the way you think. It's just a question of finding the right medication to get you thinking the way you want to be thinking. It all comes down to which sucks less? I'd much rather deal with the athlete's foot, the morning sinus clearing, food not tasting as good as it used to, and being somewhat more lazy than most people than being so insane that The Answer was to go to Liberia in 2002 and find someone who would give me a machete and just take it from there.

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 of yourself, 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.
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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 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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