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Dr. Bob is Robert Hsiung, MD,
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Posted by ben on March 3, 2002, at 9:39:48
What are the main differences between these three antiepileptic drugs concerning pharmacodynamic effects ? The information about the use and side effects are very controversal and confusing. I am unipolar and do have a pain syndrome (perhaps neuropathic pain) in the legs. Which does affect pain at most, which one has the fewest side effects (fatigue, dizziness...) and which one is a good mood stabilizer ?
Posted by Ritch on March 3, 2002, at 11:13:47
In reply to Neurontin /T egretol/ Trileptal - differences ?, posted by ben on March 3, 2002, at 9:39:48
> What are the main differences between these three antiepileptic drugs concerning pharmacodynamic effects ? The information about the use and side effects are very controversal and confusing. I am unipolar and do have a pain syndrome (perhaps neuropathic pain) in the legs. Which does affect pain at most, which one has the fewest side effects (fatigue, dizziness...) and which one is a good mood stabilizer ?
Hi,
Neurontin has the most benign side-effect profile of the three and it doesn't interact with other medicines affecting their levels like Tegretol can. However, the down-side of Neurontin is you need to take it 3+x daily to keep enough in your system as it is washed out very rapidly. Some people complain about excess fatigue while on it and feeling "spacey", etc. Tegretol has been around for a long-time and can be quite effective for pain syndromes, too. Its biggest setback is it can drastically alter the blood levels of other medicines you are taking with it (or might take with it in the future). It also can trigger a rare incidence of agranulocytosis (a blood disorder). Trileptal is similar to Tegretol, and nearly eliminates the blood disorder problems and can be mixed up with other meds without causing trouble like Tegretol. I have tried all three for bipolar disorder. Trileptal has a propensity to cause a lot of nausea. I am sensitive to nauseating meds-so I can't tolerate it. Topamax is another AED that some have had success with for migraines and pain syndromes. The trouble with it (for many) is cognitive blunting, trouble thinking, memory probs, etc.
hope this helps,
Mitch
Posted by ben on March 3, 2002, at 13:00:49
In reply to Re: Neurontin /T egretol/ Trileptal - differences ? » ben, posted by Ritch on March 3, 2002, at 11:13:47
Thanks Mitch
But doesnt Tegretol cause nasty fatigue too !?
It is said to have the most AD effect of these three meds ?!
Posted by TSA West on March 3, 2002, at 13:49:52
In reply to Re: Neurontin /T egretol/ Trileptal - differences , posted by ben on March 3, 2002, at 13:00:49
Carbamazepine in depressed phase of bipolar disorder:
Post et al (1986) reported in a double blind, placebo-controlled trial that in 35 bipolar depressed patients most had some improvement with carbamazepine. Interestingly, in the on-off-on design most patients failed to relapse on placebo --http://www.vh.org/Providers/Conferences/CPS/11.html
Posted by Ritch on March 3, 2002, at 14:48:50
In reply to Re: Neurontin /T egretol/ Trileptal - differences , posted by ben on March 3, 2002, at 13:00:49
> Thanks Mitch
>
> But doesnt Tegretol cause nasty fatigue too !?
> It is said to have the most AD effect of these three meds ?!Yes, at higher doses people complain about cognitive problems and fatigue with Tegretol (and all AED's I have heard about-at high enough doses). Tegretol's structure is similar to a tricyclic antidepressant and some people do get a prominent AD effect from it (I didn't really though). However, when I was on Trileptal I *did* get a definite "buzzy", "wired", almost pstim like effect after a few days on it. But the nausea was just too much and I ditched it. My pdoc told me some patients go manic on Trileptal when being switched from Tegretol and have to be switched back. Maybe Trileptal isn't too good of an antimanic agent after all.
Mitch
Posted by ben on March 4, 2002, at 2:30:08
In reply to Re: Neurontin /T egretol/ Trileptal - differences » ben, posted by Ritch on March 3, 2002, at 14:48:50
Thanks all
I would be interested in AD effects, because I am not bipolar at all ! I have depression since more than 2 years without (hypo)manic episodes. Tried Lamictal in a tiny dose of 5 mg/ day and felt stoned....my pdoc said it could have stimulating effects !?
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