Bipolar Beat

With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. This week, we focus the spotlight on Tegretol (carbamazepine) – an anti-seizure medication that has been found useful in treating bipolar disorder. Following are some of the primary benefits Tegretol offers:

  • Useful in treating acute mania and mixed states particularly when a person doesn’t respond well to or tolerate lithium or valproate (Depakote).
  • May also help with maintenance treatment – reducing the frequency of all cycles.
  • Does not typically cause significant weight gain in most people who take it.

Although most people tolerate Tegretol, it does have some drawbacks and negative side effects, including the following:

  • Can reduce effectiveness of birth control pills.
  • Has potentially serious interactions with a number of other medications.
  • May lead to reduction of white blood cells or platelets. Your doctor will want to run blood tests before beginning treatment and regularly thereafter to monitor your white blood cell and platelet counts and the concentration of Tegretol in your blood.
  • Could cause or contribute to liver problems. Again, your doctor may order liver function tests before starting carbamazepine and then about every six months to rule out any problems.
  • Blurred vision.
  • Difficulty with balance and walking called ataxia.
  • Nausea.
  • Severe skin reaction called Stevens Johnson Syndrome.

The possibility of the severe skin reaction from Tegretol has always been known. However, recently it has been discovered that people of Asian ancestry who carry a specific genetic marker are at particularly high risk of a dangerous skin reaction from Tegretol. This means that if a physician wishes to prescribe Tegretol to a person of Asian ancestry, they will need to get a test for this marker which is called HLAB*1502. The test is already commonly used in transplant patients and is readily available. The marker is not a genetic abnormality but rather just one of many possible variations. This variant is found almost exclusively in individuals of Asian ancestry. The skin reaction can happen in other people without the marker, so monitoring for skin reactions is still important regardless of ancestry.

Tegretol is used far less often than Depakote – for no particular reason it seems other than habit on the part of physicians. It is a good medication with a generally well tolerated side-effect profile, but it does require frequent blood tests and can be difficult to use in people who take a number of different medications. While Tegretol may be used alone to treat bipolar mania and cycling, it is also used (and possibly more often) as an additional agent – layered on to something like lithium or Depakote.

Unlike lithium and Depakote, there seems to be no set blood level (concentration of Tegretol in the blood) that is considered therapeutic (effective in preventing mood cycling). But there are levels in the blood that can be too high, so blood levels are still drawn regularly. To prevent negative side effects from occurring, your doctor is likely to start you at a low dose and ramp up the dosage slowly until symptoms appear in control.

Tegretol has the unusual property of causing its own blood level to drop as the doses are increased. Tegretol pumps up the activity level of the very enzymes that break it down, so frequent blood level checks are necessary at the beginning of treatment until the enzymes are maximally “induced” in this way.

Another anti-seizure medication is available that’s actually one of the breakdown products of Tegretol – called Trileptal (oxcarbamazepine) – that does not require such regular blood levels and does not have some of the other potential risks of carbamazepine. Physicians have begun prescribing it to treat bipolar disorder, but there is really no data to support its use. One study was done in children and adolescents, which showed the medication was no better than placebo. Adult research is almost nonexistent. Trileptal carries a risk of lowering sodium concentration in the blood, so sodium levels must be monitored if someone is taking Trileptal.

Caution:Tegretol comes with several warnings, including the following:

  • Never stop taking any medication cold turkey, especially an anti-seizure medication. Withdrawing an anti-seizure medication too quickly can actually cause seizures. Always consult your doctor before you stop or decrease your medication.
  • Grapefruit and grapefruit juice tend to increase the concentration of Tegretol in your system, so avoid it if you’re taking this medicine.
  • Because Tegretol can decrease the effectiveness of contraceptive pills, be sure to tell your doctor if you’re taking the pill to prevent pregnancy. Also let your doctor know if you’re trying to become pregnant.
  • Be sure to tell your doctor if you are taking or about to start taking any other medications, herbals, vitamins, or over the counter products because many substances can affect levels of Tegretol in the blood.

If you’ve taken Tegretol for bipolar disorder or are a doctor who has prescribed it, please share your experiences, insights, and observations.


Related Posts

You can leave a response, or trackback from your own site.

Links to This Article

Bipolar Blog | Bipolar Disorder | Tegretol | Carbemazepine (August 29, 2008)

From Psych Central's Dr. Candida Fink & Joe Kraynak:
» Bipolar Medication Spotlight: Trileptal (Oxcarbazepine) - Bipolar Beat (September 16, 2008)

From Psych Central's Dr. Candida Fink & Joe Kraynak:
Mood Stabilizers for Bipolar Disorder - Psych Central (January 14, 2009)

From Psych Central's Dr. Candida Fink & Joe Kraynak:
Bipolar Disorder Q&A: Why do I suddenly have lithium toxicity? | Bipolar Beat (May 26, 2009)

30 Comments to
“Bipolar Disorder Medication Spotlight: Tegretol (Carbamazepine)”

I am on Tegretol for bipolar and I have a sore patch on my foot which won’t heal and constant infections. My ESR level is raised, my eyes are often blurred and I get a dry mouth. I get a bad back and have taken Ibuprofen today for the pain. Does Ibuprofen interfere with the efffectiveness of Tegretol? Which other medications should I avoid? Is Paracetamol OK?

Hi Karen -
It sounds like its time for a sit down with your doctor to discuss these concerns. I can’t offer you specific medical advice here - but your doctor should be available to you to answer these questions and weigh out the pros and cons of your current treatment regimen. Ibuprofen is not generally considered to be contraindicated with Tegretol, but everyone is different.

Before you start any new medications, over the counter or otherwise, you should check with your doc to see if there is an interaction with your current medications. The pharmacist can run a check for you as well, but it’s best to let your doc know about any meds you are taking.

Candida Fink MD

im taking tegretol for maniac depression…. i was just wondering if i will gain a lot of weight i was just put on it today. PLEASE get back to me

nicole burkey

About 22 years ago,as a teen, I was diagnosed as having epilepsy and prescribed Tegretol. I took this drug for 18 months while begging to be changed to something else. I became severely depressed and eventually attempted suicide. I will alway attribute Tegretol as a trigger to my first major depression. From which I never fully recovered. Even after coming off the drug. I have learned recently that epiletic people do have a greater risk of suicide and I’m sure the diagnosis it-self was a factor in the depression, I still hold the drug very responsible. And I think it’s worth mentioning that recent studies have shown a link to increased suicidal behaviors and Tegretol, along with 10 other drugs in the same class.

Thank you Melissa for pointing out this potential side effect of Tegretol. There has been a lot of discussion recently about the possibility of anti-seizure drugs triggering suicidal thoughts, similar to the antidepressants. I think the jury is still out on whether or not to put a “black box” warning on these medications because this side effect is felt to be quite uncommon. But you describe an incident that certainly may have been related to your Tegretol. And even in if a side effect is rare it isn’t any less difficult when it affects you.

As you also point out, there are increased incidences of depression and suicide attempts in people with epilepsy. These kinds of “layered” risk factors cause much of the difficulty in teasing out what factors actually trigger mood changes and suicidal thoughts during a medication trial.

Thank you again for your insights -

Candida Fink MD

Nicole -
regarding your question about weight gain i can only say that weight gain is not a typical side effect of Tegretol - that is one of its benefits. However, everyone is different so if you are concerned about this side effect please discuss it with your doctor and see what she recommends.

Candida Fink MD

I did not have weight gain with Tegretol. Actually the reverse was true. I lost weight. However, I cannot say that the weight loss was a result of Tegretol either. As it very well could have been caused by the severe depression or another drug that I was given to counter-act the side effects of the Tegretol. No way to be sure really but definitely no weight GAIN!

I was first diagnosed with seizure disorder just this past June. I was prescribed Tegretol due to the seizure disorder. I experienced adverse side effects of this drug. Some were severe headaches, extreme dizziness, total lack of sexual drive and blurred/double vision. I believe that these Tegretol side effects alone brought on my depression (which I am about 2 months into treatment for). My seizures actually stem from a putitary gland tumor in my brain. It has taken almost 4 months, and 3 different specialists to figure this out. I am still on the road to getting better, as I face a possible surgery for the tumor. But, as for my experience with the Tegretol, I will never go back on it again! I do believe there should be major corrections and better drug info for the doctors before prescribing this medication to anyone.

I was just prescribed Tegretol (200mg) today for treatment of bi-polar disorder. I’ve been on Epilim before and hated it, and am really worried that this drug is going to do the same to me. I want to be better and for my moods to stop but at the same time, I can’t handle feeling bombed, not being able to walk and talk properly etc. Is it common for this drug to do that to people? My psychiatrist has also prescribed it with 300mg of Efexor XR daily. He wants me to stop taking my Lexapro immediately and go straight on to that. I thought you weren’t supposed to do that? He seems to think I will be ok, because apparently I have a high tolerance level to treatment and he thinks it’s not working anyway. Can anyone give me any advice here please…I want to be better, but I am scared of being out of it on this new drug.

i was prescribed tegretol about 10 years ago now for bi polar..i guess that was before full cbc counts became a must for this medication..i was in inpatient treatment during the time and i guess because of that i was less believable then a “normal” person..i went for 3 weeks being weak the slightest touch bruised me severely finally a kind hearted resident that was rotating through my floor saw me and i guess said something to the doc who ran the cbc that saved my life, i went from the psyc floor to the pederatic icu in less the 1 hour..the drug caused my platelet count to fall to fatal levels and the hematologist i saw told my mother and i that i was lucky to be alive..after 6 platelet and imunoglobulin transfusions i was told that i had liver damage but my platelets were normal..please if you take this drug be careful side affects may be rare but they do happen..i was 13 and almost died i haven’t took any drug since then and i see a therapist to try to work through my manic ups and downs..i haven’t been able to drink like other college students and i have to avoid anything that may cause damage to my already compromised liver..if you see any bruising or feel different not like yourself tell your doc..DEMAND that they run test..because i was a kid in the psyc ward i almost died because noone would listen to me..make yourself heard

I am in my late 30s and have had Bipolar I disorder throughout my twenties and of course I still have it. I was prescribed Tegretol in an inpatient setting in a hospital psych. wing in 1991 and developed Stevens-Johnsons sydnrome while on it. Albeit the drug caused a SEVERE side effect like that I loved the way the drug controlled my moods. It allowed me to be me, without the sedation, confusion and quasi-numbness of Lithium. I am currently on Lithium and hate it, very very much. I have gained 100 lbs on it along with the atypical psychotic risperdal. I have begged my doc. to take me off of it, and he won’t. I don’t want the tegretol but does anyone out there no of a drug as good as Lithium without the tremendous weight gain? Please write.

I just stopped taking Tegretol after trying it for 3 weeks. It made me so dizzy and tired and could hardly walk straight. And I’ve still got a constant crushing headache. I tried it as an alternative to Lithium. I’ve gained 25 pounds on Lithium and I hate feeling slow and so darn exhausted all the time. But at least I wasn’t depressed. Just a jolly fat gal.
Is this the way it’s always going to be? I so hoped Tegretol would allow me to lose weight and stabilise my moods.
I live overseas, and I feel so lonely with my problem. I can’t go to the therapy or support groups because I don’t speak the language well. I feel so upset that the Tegretol didn’t work out for me.

We had great success with Tegretol with our son, now 14, who was diagnosed with bipolar disorder. He started on tegretol at age seven and has been on it ever since. It was very good at stopping his aggressive behavior, and prevented him from getting kicked out of first grade for bullying other kids. I think in retrospect he was having seizures, where he would blank out and then try to hurt other kids, and the Tegretol, being anti-epileptic, put a stop to that. He did have the dizziness and slurring of words for about three weeks when he first went on it and the doctor is extremely careful about testing his white blood cells and liver to be sure they are OK.No weight gain, either

My sister, 57 years old has been on Tegretol plus other antipsychotic medications for about 3 years now. The doc reverted to this after having used Risperdal,Zyprexa which she did not tolerate. She also gets a monthly ECT. She has been quite well with this treatment. Any comments, esp re ECT monthly?

Can discontinuing Tegretol lead to having less control of angry emotions? Our son took it during for many of his childhood years to treat Seizure disorder. He stopped at 16 yrs and has had more angry outbursts since then? IF so, what can be done?

Keith

Hi Keith
Tegretol is effective in reducing irritability and angry outbursts for many people, with and without bipolar disorder. It is possible that the Tegretol was managing some type of underlying mood dysregulation along with the seizures. I don’t think that stopping the Tegretol would create a new mood disorder. Perhaps it may be some combination of his being an adolescent, with lots of new strong feelings - but when he was younger and on the Tegretol his experience of emotions, especially anger, was significantly reduced, Perhaps he hasn’t developed skills for regulating himself effectively because his responses were more muted by the meds.

I would review this with his neurologist and conside a psychiatric consultation to explore things further. Some type of therapy may be valuable to help him explore his emotional responses and develop new and more effective skills for managing his responses.

I was recently diagnosed with Cyclothymia. I guess a milder for of Bi-Polar, where the ups and down are more frequent, but less severe. This condition has inmpacted my personal life a great deal, and I sought medical help. After meeting with a psychiatrist he prescribed me Tegetrol. I am terrified of all of the potential side effects and drug interactions. I am wondering if it is worth it at all….

Hi,

I have been on tegretol from the age of 15 to 24. So 9 years. I have had many mood problems and changes in behavior in that time. I did not realize until a couple of years ago that it was most likely because of the tegretol. It’s like I’m a completely different person. I take the medication because I have epilepsy, but I think the medication may be worse than the disorder itself. I have a had many bouts of depression and have tried to talk to my doctor about it to maybe try an antidepressant. He said he would look into it and try to find one that would not interfere with the tegretol. He never got back to me and I continue to go through very depressing times. Alone. No one in my life realizes how awful it is to be on this medication, or how much it has affected me. I have had thoughts of suicide in the past, but I know it’s not really me feeling that way, and that it’s just the drugs. I have major mood swings, and it affects every one of my relationships. I have done my own research online to try to find something to take for the depression, while on tegretol, but there does seem to be anything. please help. Not taking tegretol is not really an option though, for many reasons. There has got to be something out there.

I was just put on 200mg of tegretol a couple of days ago by my family doc. My family doc prescribed tegretol after reading a psychiatric evaluation on me.

The psychiatrist who evaluated me thinks that I have bipolar 2 because of my rapid and cycling moods.

To furthur complicate matters I am on the autism spectrum as well. I have been diagnosed with minimum brain dysfunction, NLD—non-verbal learning disability and asperger syndrome depending on which psychiatrist I have been evaluated by.

I am a 46 year old male. Hopefully the tegretol will help stabilize my mood. I am being bullied by my building superintendent who I keep telling to f*** off.

My family doc was afraid that my building superintendent was going to provoke me to do something violent like punching him or something. That’s why she put me on the tegretol.

I’ve been on the tegretol for 2 days and already I am starting to feel less aggressive and hostile.

I am also taking a 0.5mg dosage of clonazepam as well 3 times a day.

I quit taking tegretol after a week. I couldn’t take the horrible side effects.

I view this as a deterrent to help me improve my mood cycling myself. We’ll see what happens. My family doc is aware of my decision and she’ll be observing me very closely in our weekly visits.

I’m back on the clonazepam for now.

I have been taking tegretol for approx 10 years for bipolar. For the past 3 years or so, I have had a steady increase with ringing in my ears. I have gone to several MDs, including ENTs, and no one even considered it as a effect of the tegretol. If I were to come off the drug, will this condition subside or be completely eliminated?

Hi,I’ve just started Tegretol and it has really calmed me down. My psychiatrist doesn’t believe that I have Bipolar (he thinks that I have schizophrenia), yet I have no symptoms of schizophrenia other than the depression. I asked to be put on a mood stabilizer and have responded really well to Tegretol. I guess I do have Bipolar 2 I think and sometimes I realized that you have to do your own research and thinking and cannot rely on your psychiatrist completely. The Tegretol is great though. My thoughts aren’t racing and I feel at peaced. Good luck all.

Danielle-
I have been on tegretol for about 2 years now and I haven’t gained any weight like I did on lithium. By far I think tegretol has been the best medicine considering the little side effects. Compared to medicine like lithium and depakote, the side effects I experienced for the first 2 months of taking tegretol were minimal. I gained 25 pounds on lithium and the depakote made me get sick all the time!!! However, I have never noticed the calming effects that other people talk about having from the tegretol. I’m bipolar and have frequent manic episodes that last 2-10 days at a time. I take the tegretol for epilepsy. I didn’t even know it could be used to treat bipolar disorder!! Good luck…

I was just put on tegretol today…I was just wondering about anyone else’s experience with the drug. I am taking it for Bipolar 2, in addition to zoloft…has anyone else taken this combo, if so what were your results???

I have been on tegretol retard for quite a few years now. But I have got tiny tiny little pin prick red spots on lots of areas of my skin plus a persistant white-ish patch in the very back area of my mouth (where my throat is), I often feel as if I have a sore throat. Are these any thing to do with the tegretol at all?

My 30 year old son just became epileptic in the last two years-minute scar apparently in right temporal lobe from being a forceps birth. After first being put on Dilantin, he is now on Tegretol, 600 mg. a day. He has a horrible cold, is there anything he can safely take to help his cold. Pharmacist said Sudafed may be OK-I searched the internet-Sudafed not such a great idea!

Six weeks ago my psychiatrist took me off trileptal and put me on tegretol because of a serious sodium deficiency. I had also become more impulsive and reactive.

Sodium levels improved quickly, but the other symptoms have become worse so this class of drug doesn’t work well for me anymore.

I was put on 200mg of tegretol Tuesday. Also my doctor put me on 20mg of Celexa. I supposently have borderline personality disorder. I have 2 kids a husband and a job! I feel so spacy like I am on drugs. I feel like I don’t really care about anything. The sun light makes me weird and I feel like I was better off crazy before. I recently lost weight and I am terrified to gain it back. Does anyone know if weight gain is a side effect? Thank you so much.. Oh how long should I feel like an air head too?

I started Tegratol 2 days ago. I have been taking Prozac for a few weeks and Cymbalta prior to that. I have been off and on anti depressants my whole adult life.
In the 2 days i have taken Tegratol ( for BiPolar 2) i have had some odd side effects- none of which i see listed anywhere. My speech slurs a little, my eyes crossed on their own ( i can’t do that even when i try)i misspoke common words. Things like that. Anyone else have anything like that? Right now I am on one 200 mg at bedtime and will increase that and add one at lunch too.
Thanks so much

Loren,

I’m on 600mg Tegretol (200 in morning) and 400 before bed and 10mg of Anafranil (Clomipramine) in morning. Anafranil is a tricyclic anti-depressant. My psychiatrist thinks that the tryciclics may work well with Tegretol. I’m only 5 weeks on this mix and have felt normal over last two weeks. I was rapid cycling prior to that although depression is the main problem for me also. Perhaps you could suggest this to your doc? Best of luck. Your post was months ago. I hope you’re not still struggling with the meds

Ask a Question or Post a Comment:

*
To prove you're a person (not a spam script), type the security word shown in the picture. Click on the picture to hear an audio file of the word.
Click to hear an audio file of the anti-spam word

 


Candida Fink, M.D. and Joe Kraynak are authors of Bipolar Disorder for Dummies. Pick up the book today!
Best of the Web - Blog 2008

Recent Comments
  • Bobbi J: My doc just told me that he classified me as BiPolar II, that I only reach hypomania so I have dealt well...
  • Joe: Hi, Amazon– You said… “Maybe I shouldn’t even be posting because my manias aren’t very...
  • Bill: cymbalta + lamactil + trazadone has been a life saver for me. Cymbalta and Lamactil alone did not fully treat...
  • DAWN: MY BOYFRIEND WENT THE DR TODAY. HE WAS PRESCRIBED NEURONTIN, THE DR TOLD HIM TO FIND HIS DOSE, THE BST THAT...
  • Amazon: Thanks, Joe for bringing up this topic. When I was first diagnosed bipolar everything I read was so...
Article Tools
Bookmark
Print
Email Friend


Stumble It!


Subscribe to Our Weekly Newsletter


Users Online: 712
Join Us Now!