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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by sczacovi on February 25, 2006, at 15:08:31
has anyone ever had or heard of someone having joint/bone pain as a side effect of these two meds or just lithium? Please help. My son has epilepsy and bipolar disorder. He is taking 900 mg. of Lithium ER and carbatrol and a variety of other meds. He was on depakote, but was just weaned off b/c neuro thought that might have caused pain. Had numerous blood tests, everything normal. It would help to pinpoint if one of the drugs listed above is the cause. Having lots of seizures since being taken off depakote. The only common denominator is lithium. Thanks.
Posted by med_empowered on February 25, 2006, at 20:13:51
In reply to lithium and carbatrol combo, posted by sczacovi on February 25, 2006, at 15:08:31
Lithium is "pro-convulsant"; like many other psychiatric drugs, it can make seizures **more** likely, not less. My guess is that the depakote prevented your son from having seizures; once the depakote was taken away, your son's epilepsy + the lithium combined to cause more seizures.
Most anticonvulsants seem to help with bipolar AND epilepsy, so it seems like your son should be able to treat both conditions with anticonvulsants instead of having to use lithium or other pro-convulsant drugs in the cocktail (unless he's failed trials of other drugs).
If he's on carbatrol at the moment, you could try using Trileptal (oxcarbazepine) instead; since it doesn't have as many side-effects/toxicity issues, you can ramp up the dosage more (to control the epilepsy AND mood disorder) with fewer side effects. You could also temporarily add Klonopin (clonazepam) or Frisium (clobazem). I don't know about Frisium, but I know Klonopin tends to lose effectiveness after about 3months; it can help bipolar a little and epilepsy, so you could use that 3months to find a more effective, permanent medication to use.
Have you tried/considered lamictal? It might not be the best idea if your son runs towards the manic end of things, but it can help alot with bipolar, especially if there's depression involved. Because of drug-drug interactions, you'll probably need to do a lot of dosage adjustment with it if he's also taking Tegretol, Depakote, or any barbiturates...there's also the risk of a rash, which is more common in younger people than in adults.
You could also try something old-school and try Phenytoin (Dilantin). Some data indicates it helps with bipolar where other drugs have failed; its also available as Dilantin-P, in which it is combined w/ low-dose phenobarbital.
If pain continues to be an issue, you might want to consider Lyrica or Neurontin; neither of these meds seem all that helpful for bipolar (at least not alone), but they can treat some sorts of pain AND control epilepsy...they might also have some anti-anxiety action.
Finally, there's Keppra; its new, and seems to be very helpful for some forms of epilepsy (I think its used as an add-on treatment). Its also helpful in bipolar disorder and possibly in other issues, such as social phobia. The downside would be possibly inducing depression. Its clean, so you won't need to worry about drug-drug interactions.
GOod luck!
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