Expert: Ivan Goldberg, M.D. - 11/3/2006

Question
My first manic episode was while I was on Keppra for epilepsy. 6 months off meds I had no bipolar symptoms. 1 month on dilantin I had 2nd manic episode. I also had bad depression and anxiety on either Lamictal or Trileptal. Could I be reacting to the meds and not be true bipolar. Or can these meds make Bipolar worse.
Joanne
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The text above is a follow-up to ...

-----Question-----
I read a reply you gave about dilantin to treat bipolar. I am interested in the other anticonvulsant your patient had success with. I would like to discuss this with my Doctors
I have uncontrolled epilepsy for 30 years and this year a new problem, I have had 2 manic episodes, one while on dilantin. I haven't been started on meds for bipolar yet.  Joanne
-----Answer-----
Hi, Joanne . . .

The anticonvulsants that are most often used to treat people who have bipolar disorder are: Depakote, Tegretol, Lamictal, and Trileptal. Occasionally, Keppra and Zonegran have been useful.

Best regards . . .

Ivan

Answer
Joanne . . .

It is impossible for me to say much about your situation based on the data you provide. If a patient came to me with a history similar to yours, and especially if there was a family history of mood disorders, the next thing I would do would be to start divalproex (Depakote).

To answer your question about the possibility that your mood symptoms come form the meds, the only possible answer is yes. But remember that while many things are possible, not so many are, in fact,in fact probable.

Best regards . . .

Ivan
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