Bipolar and epilepsy! Whats with these meds?? Help!!

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Hey guys,

Well basically i have epilepsy and bipolar, neither of which are well controlled. Im on 400mg lamotrigine  Day for both conditions, 250mg keppra for the epilepsy and started on mirtazapine 15mg 4weeks ago for a depressive episode. I'm now going through hypomania! I thought lamotrigine was supposed to basically be a 'miracle drug' for bipolar?? Anyone know whats going on? Not got psychologist, psychiatrist or neurologist for a while. Need help pleeaaassee.... Any advice or info would be really appreciated right now!

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  • Posted

    It's very interesting to me that you have both conditions.  I have long suspected bi-polar has some characteristics of epilepsy.  I firmly believe it is entirely a neurological disorder versus a "mental" disorder, although it manifests itself in mood.

    Lamotrigine is an awesome drug!  However, it's not the best for treating mania.  It's very mild - even at 400mgs it doesn't have near the depressant effect of traditional drugs like valproate.  Have you tried any of the stronger anti-seizure drugs?  If you can handle valproate I know it's very effective at preventing mania, however it has it's downsides.  As a rule, drugs that strongly interfere with Sodium and Calcium channels in the brain make me misterable, which is why I'm a fan of Lamotrigine (if it's working for you, which it obviously isn't)

    I don't recommend Lithium with your situation, and probably adding the mirtazapine is not the smartest move.  Part of the problem wth you situation is that you are combining drugs and it's hard to know what's causing what.  I realize the popular trend in treating bi-polar is a combination of drugs these days, but throwing too much in at one time makes it really hard to evaluate what's working for you and what isn't.

    Here's a suggestion - talk to your doctor about loosing the Mirtazapine, and possibly cutting back on the anti-consulvants.  The big risk with your situation is the epilepsy, but perhaps the lamotrigine alone would be enough if you weren't throwing anti-depressants in the mix?  I always favor a minimalist approach to medications.  It's been my salvation, although I used to believe I needed to take 12 different drugs and that one more might fix things - I ended up taking almost nothing, and I feel much better - I still get mild highs and lows, but not extreme, and the less cycling into hypomania, the less severe the inevitable depressed phase that follows.

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  • Posted

    Geeleigh I also have epilepsy and take lamotrigine ER (Extended Release 500 mg), levetiracetam ER (Keppra, 1500 mg) and mirtazapine (45 mg). A few years ago my Dr. made an unofficial medical remark that I might also be borderline bi-polar and has not mentioned it since then. After a massive seizure, my Dr. switched me to Lamictal (400 mg?) There were no generics lamotrigine then. I'm now forced to take the generics now, because of insurance, I live in America, won’t cover the cost of the name brand. (Generics are given a latitude of being the same medicine as the name brand. Some on the web say it’s within the limits of +/- 20%, others say it’s within the margin of +/-15%). Switching to only Lamictal back then was like opening a door and letting the sun shine in. But it also had a bad side effect, massive insomnia. I couldn’t shut my mind down to go to sleep. My Dr. switched me to Keppra (also no generic at that time). I became very angry and the slightest thing could tick me off. Another guessing game of meds made my mind, for the lack of a better word, stupid. I ended up going back to a combo of lam. and levet., 500 mg of each. He also gave me Zolpidem (Ambien) for sleep. I wish he had given me zolpidem when I was on lam. alone!!!!! I don’t have the ton of anger now, but I have depression. Now on 45 mg of mirtazapine. After seizure problems this last summer, he switched me to 500 mg of lam. ER  and increased me to levet. ER to 1500 mg. But even when taking zolpidem and mirtazapine at bedtime, I couldn’t sleep. Went back to 500 mg lam./levet. But after a recent intense aura, I decided to go back to the ER’s, except this time I alternated between the regular lam./levet. and the ER's to let my mind to use to it and began only taking the ER’s last week. I sleep now, but not as long as I’d like to.

     

    In short, the mirtazapine helps with depression but it also has an unwanted side effect of lack of motivation I sometimes can’t get over. Your Keppra may be counter acting the lam. I think it does in my case. Stephen mentions valproate. Using that might essentially double the concentration of the lam. in your system. The dose of lam. will have to be adjusted if you take it. I hope your Dr. knows that. Lam. is also known to cause a skin rash. REPORT any skin rashes to your Dr. A severe skin rash disorder and potentially deadly one is known as Stevens-Johnson syndrome, can be caused by Lam. It is rare, but starting on a sudden high dose of valproate can increase the chance. So your Dr. should know that starting valproate needs to be increased slowly if you go in it.

     

    Mirtazapine also effects the mind, not always for the better. I like it except for the lack of motivation. In a low number cases, mirtazapine might increase mania. Did you notice any changes after being on it? It is supposed to be one of the best anti-depressants. If you go to the discussion groups on mirtazapine, some people have trouble with it though. You’ll find a lot of negative feedback, but I think they are a minority of people on mirtazapine.  

     

    Right now I think I’m stuck in a place where I don’t want to be. I think I’ll ask my Dr. to increase the dose of lam. and decrease the dose of levet. Lam. is noted to be one of the better drugs with fewer side effects for bi-polar disorders and epilepsy.

    Keep well.

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  • Posted

    Hi,

    I can't really comment on all of what your on, however I have epilepsy and type 2 bipolar, but what I do know is a few years ago before me or anyone else thought I had another condition other than epilepsy and I was on keppra and it's apparently an amazing or an awful drug, but all I have to say about it is it's the worst medication i have ever been on it made me moody, depressed and kept getting worse, epilepsy specialists are supposed to advise patients if keppra affects your mood, they need to change it as soon as possible and replace it.

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  • Posted

    Hi  Geeleigh.

     I too suffer from both epilepsy and Bi-polar. Since 1991 I have my epilepsy under major control. For that, I am taking Carbamazepine and divalproex as well as Primidone. The carbamazepine acts as both an anti convulsant and a mood stabilizer. I don't suffer from grand mal seizures any more and I don't suffer fro  severe deopression either. Have you ever been on carbamazepine? It works great.

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  • Posted

    Hi, I don't suffer from epilepsy, and I haven't been formally diagnosed with bipolar (yet), however I'm taking mertazapine for depression and carbamazapine for the mania.

    I've read that carbamazapine is also used with epilepsy.

    Hope this helps

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  • Posted

    Hi again Geeleigh, It's mjmdesk writing again. In my previous post I mentioned that I was taking Carbamazepine and Divalproex. I must admit that I still suffer from hypomania. I have lack of motivation, spend too much and have trouble with sleep disorder. I am on very high doses of these medications. My new neurologist was going to try me on lamotrigine but said I would have to be off the divalproex for a number of weeks before he would introduce lam. into my system. I had a portable brain scan with me for a week and supplied the instrument back to his lab. I have not heard back from him since. I supose that the results were positive since I have not heard back from him. I will try to make an apointment with him soon. I am not happy being over medicated. I will likely stay on the Carbamazepine though because it acts as an anti convulsant AND a mood stabilizer. I will trust his judgement. Luckily I don't suffer from depression at all. It's the mania that I'm having trouble  with. My psychiatrist doesn't know medications very well. I am hoping that lamotrigine makes a difference. Not all people react to it the same way. If you do have epilepsy, I'm sure that your GP can refer you to a good neurologist. It sounds like you may need either a change in medications in general or a change in the dosage.You need to see someone who knows medications very well and can see you regularly. That way you can talk about your side effects. Good luck finding a neurologist. xxoo
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