Antiepileptic Drug Suspected of Causing Psychosis

There has been much discussion in the bipolar blogging community regarding the pros and cons of different medications in our treatment regimens.  We wonder whether our symptoms are caused by our brains…or maybe, and this terrifies me…from the drugs we take to pacify our unruly grey matter.

The debate has largely focused on the role of antipsychotics.  Many people find their bipolar symptoms are not controlled by certain drugs: but when they try to discontinue, their symptoms rebound, or they even develop symptoms they didn’t have before, like auditory or other sensory hallucinations, tremors, and so on.

I had been skeptical of the extreme descriptions I’ve been reading, of people literally crippled by psychotic symptoms after even a very slow wean from certain drugs.  After all, how could antipsychotics CAUSE psychosis…could it be, thought I, that these people were simply experiencing a resurgence of their own “native” psychosis upon withdrawal of the “anti”?

This study, which focuses on psychosis caused by, or by withdrawing from, certain antiepileptic drugs, has literally changed my mind.  I’m now thinking about the way the brain is able to change the way it functions in its environment.  We bathe it in a substance; it learns to use and depend upon that substance for everyday function.

Sometimes, in the presence of a substance that is supposed to do one thing, our brain rebels and does something else.

This might explain why a person with temporal lobe epilepsy, as represented in the article, given a certain antiepileptic drug, might go ahead and have sensory hallucinations. 

I’m not going to stop taking my lamotrigine (an antiepileptic), because it really does help me feel better.  But this article did give me pause, since I also have temporal lobe epilepsy that causes sensory hallucinations.

Jeekers crow, I sure don’t want to have my days and nights haunted by the smell of baked goods burning in the oven, which is my main sensory hallucination.  It’s damned hard to sleep when your brain is tugging at you yelling “Get up, asshole, and take those cinnamon buns out of the oven before they’re ruined and the house burns down!”  Never mind that I don’t eat baked goods and don’t even have a house, much less an oven.  Stupid brain just goes on and on. 

Combine that with the constant intrusive music that isn’t there, and the bouts of disabling paranoia…I’ll take my chances with my  L&L cocktail (lithium and lamotrigine).

Just not that other stuff, which you will find in the linked article.  I encourage you to read it for yourself, and please do comment here!  I have some private thoughts, which I’m sure will spill over into the comments somewhere.  But I want to hear what all y’all are thinking about these critical issues of what we are putting into our nervous systems.

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  1. I’ve had much doubt about this subject for years
    Not to mention the side effects
    Christ after having my gallbladder out
    I’m wondering if the shit I have been taking had anything to do with that
    it’s all to much for me to think about
    My system is so screwed up
    That rooto rooter won’t work
    The Dr just told me that some of the stones were an inch and three quarters big
    He didn’t know how I was walking around
    So much for Dr
    And they are suppose to know
    Or bed side manner
    Or for hindsight
    I’m tired
    I’ve had it
    My tears have tears

    • Aw Sheldon, here’s a big ol hug. I’m sorry you’re at the end of your lariat. Been there, you know that, and it sucks big hairy ones.

      Did they at least give you your gallstones in a jar??? I didn’t think so. Rats.

      I don’t think brain altering drugs can cause gallstones. I’ve thought it through, and it doesn’t seem likely to alter that part of metabolism. Maybe you just had some karma to burn off. That’s what I used to tell my dad, when he would ask me why all the suffering: “You’re burning off a lot of karma.” “Burning off karma, eh?” He shrugged. Well, he shrugged with his eyes, because by that time he was mostly paralyzed. “OK, burning off karma.” And he’d give me this look that was, yeah, you and I both know this is all bullshit, but we have to believe SOMETHING. Or explain things SOMEHOW.

  2. I’m not surprised by this at all. I’ve been taking neurontin since my seizures last spring (took it before then for insomnia/neuropathy, then promptly quit, because F that stuff), and I notice changes in personality. I can’t be bothered to do or care about much, and it feels like I’m thigh deep in mud when I try to walk anywhere. I’ve been inclined to stop, just to see if it’s actually needed because I hate it. If I were all of a sudden thrown back into hyper-vigilant/hyper-active brain mode, I imagine all sorts of weird things would happen. Even tapering off doesn’t completely negate withdrawal symptoms in most drugs, particularly if you’ve been on them for a long time.

    • True. I suspect that the drugged brain makes all kinds of new relationships, synaptic connections being only one of the ways or brain communicates with itself.

      I’m also taking gabapentin (Neurontin), for muscle spasms. I notice a similar “don’t give a fuck” automaton type of feeling. At the moment it’s actually helpful, what with the family shit storm I haven’t been blogging about, and the serious health issues I haven’t been blogging about….hell, I’m happy to let it ride, for now. Before I die I’d like to go out in the desert with a whole lot of ganja and slowly withdraw from fucking everything….then withdraw from the weed, and see what “the unmedicated me” feels like. Hell, I might even like myself and decide to stick around for a while and see what happens next! Who knows, maybe my physical symptoms are due to the combined toxicities of the drug cocktail I gulp down morning and night, combined with environmental and emotional toxicities.

      I’m curious, why did they hit upon gabapentin as first-line treatment for your seizures?

      • I dunno. After my EEG, neurodoofus said he’d start with that, then possibly add on a secondary anticonvulsant if that didn’t work. I’d like to challenge it (at a later date). I don’t know that I wasn’t just really really sick at the time, and that’s why I had seizures, or if it’s actually a chronic thing. I wasn’t even told what kind of epilepsy it is. I haven’t had a seizure since April. Only one way to find out – wrap all of the hard surfaces in foam, then wait and see what happens!

        • Finally, the Rubber Room! 😄

          If the EEG was negative, was me I’d get a second opinion. Of course it’s not me, so there you go!

          • Eh, there were IED’s, but EEG hasn’t been repeated since the initial one. I value the skin on my scalp too much. 😉

            Oh, and your idea to do password protected posts is a good one. You might feel just a tiny bit better if you can get it all out and bounce it off of your must trusted peeps. KnowwhatImean, Vern?

  3. Makes me think – a lot! Thanks for sharing 🙂

  4. I’m staying on divalproex. Been steady on it for many years. Always welcome research, though. The more we know…

    • Not meaning to suggest that people ditch their meds! Like I said, I stick with my lamotrigine till further notice…”if it ain’t broke, don’t fix it” is one of my many mottoes 😉

      • I never meant to suggest that you encouraged others to go off their meds. You are an MD and know the danger of doing so, especially without one’s pdoc’s supervision.

  5. does it say specifically which drug causes psychosis? I have been on oxcarbazepine for a long time (I’m allergic to tegretol). my psychosis has been getting worse as I age, but then I have been psychotic since I was 5

  6. Having to take “mind altering drugs is the ABSOLUTE PITS! I always felt sorry for my patients when I could see the side effects and then would need to call MOD (after hours doc) to get a hold order. I have seen what all the meds do to a patient and I have seen how the patient suffers.

    I feel for you Dr. Laura, I really do. I think about you at various times and try to visualize what your life is like. You are a survivor, that is for sure. I so hope that you can be better physically and mentally, some how, some way.

    All the best karma to you,

    • I didn’t know you worked psychiatric inpatient. Nurse? You are so compassionate. I have been frustrated with the current movement to have nurses be doctors. No! There is nothing more wonderful than a really, truly NURSE. Doctors give orders, but nurses take care of people and NURSE them back to as much health as possible. Nurses have the potential to be life-changing.

      Thank you for your dose of good karma. Probably next life, if there is one, but I’m doing my best with this one. It’s very hard, I must say, not being able to work. That’s the big kicker.

      Love to you, Yvonne!

      • Yes, I’m retired RN and worked acute psych for a total of 35 years. ( 13 1/2 years off work to raise my 2 kiddos). I loved my job but the last 5 years was difficult due to constant changes by the VA system. The hierarchy were nuts and made insane and inane decisions that impacted patient care and the nurses ability to deliver good care.

        I can empathize with you not being able to work at your chosen profession because of health issues. It has to be the ultimate blow to your self esteem.

        • Actually not my self esteem. Simply that, like yourself, I loved my work with a passion. My life’s dream, and it’s horrible not to be able to just effing go to work and do what I love. I’m still me, just can’t go to work, dammit.

  7. So interesting. I went through venlaflaxine withdrawal last December (hectic) and am now on lamotrigine because I couldn’t tolerate anti-psychotics. I’ve actually been thinking about the personality change for a while now because my personality has definitely changed as I changed meds from venlafaxine to lamotrigine. Is it the effect of the venlaflaxine withdrawal and the brains adaptation? Or is it the effect of the new intervention of lamotrigine? Who knows…? When I took olanzapine last year, I was a different person – total, complete personality change. I changed from introvert to extrovert, and wasn’t manic. So reflecting back I can identify a personality change with drugs over the years. It really bothers me, because as you say, who am I really (will the real Slim Shady please stand up). I change with the moods of bipolar, and I change with the effects of different drugs. Silver lining…. Despite bipolar, I am consistent – in that I constantly change 🙂

    • Sigh…my motto is, “change is the universal constant.” I’m sure it’s not exclusive to me!

      I guess if we can get used to surfing the waves of change, we’ll be OK. Only problem is, the changes of bipolar, by its nature, sweep us up, engulfing us in agony, ecstasy, and every unhealthy mixture in between. Heaven help us.

  8. Hi Laura, I was on Lamictal, without Lithium, for 5 years and was hypomanic the whole time eventually ended up in the hospital full blown manic! There they took me off the Lamictal and put me on Lithium, and now after having been off SSRI’s for more than a year, NO MANIA whatsoever! Low grade and very annoying depression. Glad you’re doing well!

    • Yeah, I find that lamotrigine alone makes me irritable and speedy. In combination with lithium it balances things and mostly gets rid of the depression. Alchemy!

      • Oooooh I’m on lithium now, I should ask for lamotragine! Have the most awful case of the blahs! How are you? I haven’t been posting much …

        • I’m sorry you’re in the dumps. That just sucks so bad. We can put up with a lot, but depression…nah.

          You’ve been having some crazy weather up your way, haven’t you? I seem to notice huge changes in my moods when the weather is unstable. Hmm.

          • Thanks! Yeah, depression is something I could live without forever! We’ve just had really HOT weather! But you’re right, weird weather brings weird moods. I’m waiting for cooler weather, I start feeling better then.

  9. I think the important thing is that we listen to our bodies and how we respond to any medications we take, and pay attention to when things do change. Like, initially, going on the Pill balanced out my hormones, but eventually, that wasn’t enough and I’m now on the implant, because my own hormones bugger things up too much when left to their own devices.

  10. “Stupid brain just goes on and on,” lol I know that feeling.. my official diagnosis is paranoid schizophrenia rather than bi-polar, and I’ve been on chlozapine for about 7 years. My symptoms have slowly decreased, though they have definiately morphed along the way- though I put my recovery down to a lot of hard work on my side rather than just the drugs. They are a double edged blade, I think, the meds. When I was on higher dosages they knocked me out so much my quality of life was non-existant for a while.. now it is a lot better but the fuzzy feeling I experience is the morning still sucks big time :/ Take care!

    • Definitely you get the credit for your hard work in keeping right-side-up. The drugs give us a foothold, and we take it from there. Glad you’ve had success with the clozapine. Hope things keep getting better and better for you!

      • Thanks, and that is such a good way of thinking about it. The meds do give you some mind-space, but you have to do the work in using that space. Recovery definiately requires that you put the work in yourself.. Thanks for your comment 🙂


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