Jump to content
CrazyBoards.org

Recommended Posts

Hello everyone,

 

Ever since I had to restart my seizure meds (lamictal & keppra) ~Nov last year, I haven't felt right.  More irritated, depressed, and I think more anxious but not to the extent of the other side effects.

 

I told this to my neurologist and he said, okay, but usually these side effects go away, so give it 6 months, and if you still don't like it and the side effects haven't gone away, we'll try another.

 

So, I'm ready to give up Keppra and Lamictal.  What anticonvulsant has a good side effect profile and is friendlier on people who tend to be depressed.  Please do not respond with the obvious answer Lamictal, but other than that I'm looking for another.

 

I was going to study up on Dilantin, a know a lot of people are on that.

Link to comment
Share on other sites

If you're looking for something to stay on long term I would not suggest Dilantin. That stuff will ruin your gums/teeth. My dad was on it for a very long time. He had to have oral surgery several times and had to see a peridontist every six months for additional procedures. If Dilantin is the only med that will work, by all means, take it. If you have other choices, if it were me, I'd explore those before going on Dilantin. 

Link to comment
Share on other sites

My boyfriend is on Dilantin and due to it not controlling his seizures, he's on a high dose. It's toxic to the liver and, as sylvan said, can ruin your gums and teeth.. He's been on it almost a year for partial complex seizures on his motor cortex (brain tumor) He finds he's lethargic and not as imaginative on Dilantin. He is being switched to Keppra, but it has to be approved by insurance and its backed up, ugh. Dilantin isn't a great option for mood stabilizing from what we've read and been told by neurosurgeons and neurologists. He still has seizures, but no two seizures are ever the same!

 

Keppra is sometimes referred to as "Kepp-rage". Some people, rarely, get bad side effects from it. Depakote is an option, as is Tegretol or Trileptal. The combination of Keppra and Lamictal may not work well for you. It may take a few tries to get the right combo, unfortunately. Topamax is becoming more popular, but can be a bitch to get to a good dose on. Most of these meds help with bipolar mania, while Lamictal is really good for depression, bipolar or not. I see you're on Wellbutrin. That has a possibility of lowering the seizure threshold and, in some people, can be a bit too stimulating and cause anxiety and irritation. I personally can't take it because I become a basket case. That's just my personal experience, yours could be completely opposite!

 

Clonazepam is often added on for seizure disorders, but isn't as powerful as an anticonvulsant. Neurontin is great for anxiety. There are options!

Link to comment
Share on other sites

Neurontin seems like it could be a winner from a side effect profile stance.  But I'll have to ask my neurologist if he thinks it will control the seizures.  I have to admit I haven't had any seizures on Lamictal + Keppra.  Just depression, irritability, tiredness.  They sound bad, but then I tend to have a seizure and smash my car into a tree, which isn't good either.

Link to comment
Share on other sites

My husband took Keppra, and was evil, so he had to come off of it. Unfortunately, with Lamictal, it gave him the best seizure control. He was on Dilantin until last week, his new neuro decided if it wasn't even working, it was a nasty med to be on. His neurosurgeon said he may be qualified for a trial (or maybe just a study?) of a medication that is like Keppra, without the Kepprage.  I can't remember its name, and actually, neither can my husband.

 

But there are either trials or studies going on for that medication, maybe you can look it up (where is that web page with all the open trials?).

Link to comment
Share on other sites

What about Depakote? Also known as valproic acid or sodium valproate.

 

I'm on it now for BP, I had some issues with meds putting me on the depressed side, and Depakote has done none of that, it makes my depressions milder so far. For me personally, the side effects have been limited to a slightly more easily upset stomach, hair loss and hand tremors. The problem with the upset stomach was almost entirely fixed by switching to extended release, the hairloss is better since I take some Biotin and the hand tremors are ok as long as I keep the blood levels stable. No weight gain for me, though I need to eat very regularly to not be completely starved. All in all, I think the side effects are not bad at all.

 

I am not sure if the therapeutic range is different for epilepsy, but I'm at about ~75 (don't know the units) and the range for BP is 50-100. I get to that on 2x500mg a day.

Link to comment
Share on other sites

The thing I didn't like when reading up on valproic acid is that it seems to affect the clearance of my other medications, and I don't know if it's worth having to adjust the dosages of all my meds.

 

I'm not sure I want to be on a 'study drug' either... what if it does work, and it never goes to market?

 

Trileptal seems good from a side effect standpoint, but I don't know if it will work as monotherapy.

 

Honestly, I don't know much about Tegretol, but isn't it related to Trileptal?

Link to comment
Share on other sites

Off the top of my head Valproic acid (Epival or Depakote) doesn't affect clearance of other medications as much as Tegretol and Trileptal.

 

 

 

 

Effects of carbamazepine on other drugs
Because carbamazepine accelerates hepatic metabolism, it will increase the clearance of:

  • oral contraceptives
  • valproate
  • phenytoin
  • phenobarbital
  • primidone
  • clonazepam
  • topiramate
  • ethosuximide
  • corticosteroids
  • warfarin
  • antipsychotics
  • cyclosporine
  •  
  •  

 

http://professionals.epilepsy.com/medications/p_depakote_interactions.html

 

http://professionals.epilepsy.com/medications/p_carbamazepine_interaction.html

Link to comment
Share on other sites

Pretty well you are on the 2 with the least chance of having cognitive/mood effects. Keppra has, generally, the least side effects though a 4% incidence of depression. Not in me though. Lamictal was side effects free until  I went to 600 mgs. Perhaps then trying less of one and more of the other, hopefully reducing the one causing the cognitive/mood effects ? Is this combo for seizure control or something else ? With Keppra you can go up to 3,000 mgs/day, Lamical 600-1,200 mgs a day. 

 

I've been down this row before. The order my ndoc suggests for fewest mental effects is Lamictal or Keppra and if not Depakote. Mine you that is for someone with TLE and partials with secondary generalizations.

Link to comment
Share on other sites

The thing I didn't like when reading up on valproic acid is that it seems to affect the clearance of my other medications, and I don't know if it's worth having to adjust the dosages of all my meds.

 

I'm not sure I want to be on a 'study drug' either... what if it does work, and it never goes to market?

 

Trileptal seems good from a side effect standpoint, but I don't know if it will work as monotherapy.

 

Honestly, I don't know much about Tegretol, but isn't it related to Trileptal?

Yeah, I'm not sure how to put it scientifically, but they're "brothers". Tegretol is carbemazepine (sp?) and Trileptal is oxcarbazepine (sp?). I guess Trileptal is to Tegretol as Lexapro is to Celexa. Very similar but slightly different.

 

I don't know much about epilepsy, just that my aunt has it and is on Tegretol monotherapy and doesn't have any seizures. I think as a mood stabilizer, it's regarded as not quite as good as lithium or Depakote. Maybe what they give you when you've failed both of those. It's weight neutral though, so that's a big plus.

Link to comment
Share on other sites

The problem is, you don't know it isn't working until you have a seizure.  I have NEVER had a seizure on this combination (Lamictal & Keppra), but I don't like the cognitive effects.

 

Neurontin seems like it might double for anxiety, but again, I don't know if it will cover the seizures, and I heard it does a number on your teeth.

Link to comment
Share on other sites

The thing I didn't like when reading up on valproic acid is that it seems to affect the clearance of my other medications, and I don't know if it's worth having to adjust the dosages of all my meds.

 

I'm not sure I want to be on a 'study drug' either... what if it does work, and it never goes to market?

 

Trileptal seems good from a side effect standpoint, but I don't know if it will work as monotherapy.

 

Honestly, I don't know much about Tegretol, but isn't it related to Trileptal?

Yeah, I'm not sure how to put it scientifically, but they're "brothers". Tegretol is carbemazepine (sp?) and Trileptal is oxcarbazepine (sp?). I guess Trileptal is to Tegretol as Lexapro is to Celexa. Very similar but slightly different.

 

I don't know much about epilepsy, just that my aunt has it and is on Tegretol monotherapy and doesn't have any seizures. I think as a mood stabilizer, it's regarded as not quite as good as lithium or Depakote. Maybe what they give you when you've failed both of those. It's weight neutral though, so that's a big plus.

As far as I'm concerned lexapro IS celexa, minus the isomer that doesn't do crap. Trileptal has a slightly altered structure from tegretol, giving it a better side effect profile.

Link to comment
Share on other sites

The problem is, you don't know it isn't working until you have a seizure.  I have NEVER had a seizure on this combination (Lamictal & Keppra), but I don't like the cognitive effects.

 

Neurontin seems like it might double for anxiety, but again, I don't know if it will cover the seizures, and I heard it does a number on your teeth.

Sounds like you might have a hard time convincing your neuro to let you change, since it's controlling your seizures so well. But maybe not, your mental health is very important, too and as long as they're fairly certain these problems are caused by the meds, they should be willing to make changes.

Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

 Share

×
×
  • Create New...