FDA Orders Warning on Many Mood Stabilizers - Suicidal Ideations

[cowgirlnerd]

I just got this information about adding warning notices on mood stabilizers (like Lamictal - which I take).  

http://bipolar.about.com/b/2009/04/13/fda-orders-suicidal-ideation-warning-on-many-mood-stabilizers.htm?nl=1

The drugs which must now carry this warning are:

Depakote (divalproex sodium)
Gabitril (tiagabine)
Keppra (levetiracetam)
Lamictal (lamotrigine)
Neurontin (gabapentin)
Tegretol (carbamazepine)
Topamax (topiramate)
Trileptal (oxcarbazepine

I would agree with the statement that the risk is greater left untreated than with them.  My suicidal ideations are MUCH less being treated vs. not.

Of course, it's always best to be educated!

Racheal

[ILADVOCATE]

  I'll have to read that. The difficulty is that only leaves lithium as the one having the potential not to cause that and the (current) antipsychotics which have their own set of long term side effects (which I live with but since I've been asked not to discuss them I won't). I never experienced suicidal ideations from Lamictal and I found it to be quite helpful. I did experience psychosis from Trileptal and Tegretol and suicidal ideations from Keppra but they are lesser used mood stabilizers and for a reason. This can be a difficulty because if you feel suicidal you know what to do which is to speak to your psychiatrist and you know it comes from you. But when it is medication induced its harder to tell and after a while it creeps up on you. I would have to read that in detail and see what the statistics are for each medication. Those are all anti-convulsants but they work in different manners that are unrelated. As per Lamictal that's a FDA approved first line mood stabilizer that is highly effective. Some of the other medications listed are not used often.
  I will tell you what. I will bring that link to my psychopharmocologist and ask him what to make of the information and exactly what it means so I can understand it better and know how to approach it in a constructive manner. Thanks.

[ILADVOCATE]

"Eight anti-seizure (antiepileptic) medications used as mood stabilizers for bipolar disorder in the United States must now carry a new warning regarding the risk of suicidal ideation. According to the FDA, the increase in the risk of suicidal thoughts or behavior is "approximately one additional case of suicidal thinking or behavior for every 530 patients treated with an antiepileptic drug."
However, psychiatrist Dr. David Kahn of Columbia University questioned the weight of this warning for bipolar patients. In a report in the Psychiatric Times, Kahn said bipolar disorder has "far higher rates of suicide attached to it if untreated, than is suggested to occur as a result of taking the specific drugs in question. If there are, in fact, rare patients made worse rather than better, it is reasonable for both patients and doctors to be aware of this possibility and to monitor for it, but not to be afraid of the treatment since it is a very unusual outcome."

I'll cut and paste part of it. That means it is a warning and of concern but statistically is not enough for people to be heavily concerned but just to be aware. I would trust the judgment of the psychiatrist they quoted. Thanks for the information. If people read this they should just talk it over with their psychiatrist like any other medication side effect.

[cowgirlnerd]

I can always count on you to do the good research!  

The main thing is that I know - myself - if I hadn't been diagnosed and received treatment (including Lamictal), I would most definitely be dead.  The suicidal ideations I had were EXTREME prior to starting Lamictal.

I just hope that things like this article don't scare people into NOT receiving treatment for bipolar disorder.  It's like when Prozac came out and people were terrified that they would die from suicide if they took it - it's all in the individual (IMO) and should (like you said) be discussed with the pdoc.  

Lamictal has literally saved my life.

Rach

[bastet56]

I never had suicidal ideations from those drugs however, I did get prediabetes from Risperdal and psuede parkinsonism from Geodon. Lithium made me shake badly, depakote made me essentially stop doing anything and lamictal caused me other side effects which I can't remember but the dr pulled me off of it. Neurontin drove me up the wall. Made me so nervous I couldn't function. I am now on tegretol and so far so good.

[ILADVOCATE]

Well then it shows that everyone reacts differently to different medications. The most important thing is to work with your psychiatrist to find one you can tolerate and that works for you. Its good to be aware of what medication side effects are short term and long term but not be afraid of them and just as if not more important to know how they are helping you. I think any of the websites posted are good because they update themselves and allow us all to keep up to date on currently available treatment.

[LeftCoastChick]

I have to agree, I really dislike the media's blanket statements - yes as BP folks we have higher mortality rates if untreated. I wonder if they were just counting the people who hadn't been treated before and then started the meds. I can tell you, Lamictal has saved my life, I wouldn't be here now if it wasn't for that med - though I've had to augment it, but for 8 months it was the only MS I've been on. I get spring cyclical depression so I've had to augment, but only temporarily then I'll go back to just using the Lamictal. I can stand those "grey suit alarmists",  they cause more harm then good.

[cowgirlnerd]

What kills me is the alarmist giving the blanket statements - like we don't have enough stigmas to start with!

Recently, I had to correct someone in my office that said someone acted "Bipolar"  - in saying they were "crazy".  ....flew all over me.

[Twelvesgirl]

Hi!

I just started on Lamictal, and since some of you are on Lamictal, I am wondering how long it took before you started to feel the stabilizing effect. I am mixed and rapid cycling multiple times daily. My doctor said month or more, but you are the people who have taken it, can you give me an idea? She started me on 100mg in the AM for 1 week, then I'll go to 200mg twice daily. She had prescribed Risperdal which helped immensely w/ my mood but I had a horrible reaction to it and can't take it, so she gave me xanax for my attacks on as needed basis. I don't have anything else to take for moods until the Lamictal starts working, I just have to "deal" with it. I know this isn't the topic that we're discussing here, but I saw that alot of you had taken this drug and wanted to ask? Also, I have had for as long as I can remember, even before I was diagnosed w/ this, suicidal ideations, is that something that comes w/ Manic Depression? Just Depression? etc?

[LetaB]

Hey. When you get the answer to your question would you pass it on? Lamactil has done as much to clear up my suicidal ideations as it has to clear up my acne. If I spent half as much time putting my brain to use to cure cancer as I do dwelling on improving the right plan to end my life I might be a better nut. I only am on 100mg and I had to work up to that for a month doing complicated mathmatical equations to get here. Now, despite all the hype, I feel no better. I feel more blah and just as much full of sorrow. I must say I had heard such good things of Lamactil so I'm disappointed.

[Twelvesgirl]

Maybe we'll hear something soon!!! I'm in need!

[ILADVOCATE]

Lamictal takes a while to build up a blood level so I would give it some time.

[mejeba]

well, having just had my divalproex  (depakote) increased  again due to dysphoric hypomanic symptoms, I'm concerned.  I hope this increase is a temporary thing because of the extra stressors right now.  I do take Wellbutrin (had to stop Lamictal) for the depression so this is a new combo.  maybe it'll be ok.

[cowgirlnerd]

Hey!  I take Lamictal and it works wonderfully on me.  I didn't start at as high a dosage as you did - I started with the Lamictal starter pack 25 mg, then 50 mg, then 100, and stabilized on that (it took a month) then went to 200mg, where I really felt stable at 200mg.  All together, it took me about 2 months, but began to feel the effects of being stable at about 3 weeks.  

It affects everyone differently, and with you jumping right into 100mg, I can't say for sure.   Honestly, I have been told that 200mg is the maximum dosage!  400mg is A LOT of meds with Lamictal.  Did they warn you of SJS?  You should speak to your pdoc about the effects.  I bet your naseau was HORRIBLE taking that high a dosage right away!!!  

When you might realize that you are getting more stable is when you have an episode and you can recognize it and deal with it.  I used to become horrified at realizing I was in an episode - especially mania.  I have been a rapid cycler with psychotic features, and it's horrible, I know.  

My suicidal ideations come with both mania and depression.  I am more afraid of it with mania, because that's when my attempt happened.  I have been manic for the last few days - rapid cycling into depression.  It su*ks, but I have dealt with it better than I used to.  I can remember times when I would be like this when I couldn't even get out of bed then wouldn't sleep for days and have to be completely alone.  It's a process - you have to be patient and understand that Lamictal isn't a cure - by any means.  Bipolar doesn't go away with ANY drug - it's just a coping mechanism to survive.  I have been bipolar as long as I can remember - truly believing that I was bipolar as a child.  I have been on Lamictal since September 08.  I was on antidepressants since 20 and feel better now with just Lamictal.  Depression is still an issue  - but all in all, I am pretty stable.  

Hang in there.  

How do you feel so far?

[Twelvesgirl]

I haven't had any naseau at all?! I guess thats really good! I didn't know that was a side effect. I 've been on Lamictal before and I think it worked, I really have a hard time remembering my last episode, it was a very hard time, and an extremely destructive mania. I seek help during depression of my episodes, and from what I remember being on Lamictal before, I got a tan from wanting to be outside, working in my garden and being happy.
I have been diagnosed w/ BP 3x, I've always had problems w/ denial. I have finally come to some kind of "terms" w/ the diagnosis, due to the fact that I want to be stable.  
As for the Lamictal, I know its not a cure, bipolar is a chemical problem in your brain, its a disease. No medicine is a cure, but the rapid cycling, mixed state that I'm in is devastating, and if medicine won't help to even take the edge off, then why start the medicine? Whats the point of taking medicine that doesn't even help. I'm not asking if Lamictal is going to cure my bipolar, I'm asking how long before I feel the effect of the medication. My doctor and I have spoken about the rash, when she said she was starting me on 100mg, I asked if that was too high, she asked if I got the rash before, I said no, she said OK, you'll start at 100mg. OK, I said, lets get this going! I also asked the pharmacist and he said that there is way too much talk about the rash, and that 100mg is not too high a dose to start, OK I said! I'm no dummy, I hate medication, I wouldn't be taking it if I didn't have to. Thank you for your concern though. And depression has always been one of my biggest issues. With BP I've been told and read (except for rapid cycling) depressive episodes happen more often than mania w/ most people. I know thats true in my case, I think thats why my BP  went undiagnosed for so long, and just looked at as depression by my family and those around me.

So far, I think I'm doing OK, still rapid cycling which I haven't done in a long time, and have BEEN doing for about 2 months. I just want it to slow down. Its too much for me and my husband and kids going from one extreme to another, mostly explosive anger, laughing or crying w/in minutes, and days. Oh well I guess, the hand I've been dealt.

[cowgirlnerd]

My pdoc was careful when he started me on anything because I had to come off of Cymbalta after years of taking it at the same time as taking Lamictal.  PLUS, I was suicidal at the time and was refusing to be hospitalized.  

Hope it all goes well!  

Racheal

[ILADVOCATE]

I don't know what the maximum dosage of Lamictal is and only a psychiatrist could answer that question but my standard dosage was about  325 mg. for years and I really had no side effects of the kind people are talking about. After a while, many years later it stopped working and I was informed by my psychopharmocologist that at very high dosages Lamictal can sometimes worsen mania. You have to remember with anything we are discussing here the medication on rare occasions worsens a pre-existing tendency such as depression or mania. Different psychiatrists may have different guidelines due to their experience but the medication website would state the specific regulations as regarding guidelines as established by the FDA.
  I was never informed that higher dosages of Lamictal were something to be specifically concerned about. Its the rate the dosage is titrated and that can't go above 25 mg. a week by FDA law. Its frustrating going on Lamictal because it takes a while to build up to a proper dosage at that rate but you have to go by the guidelines your psychiatrist themselve must follow. With any medication when your psychiatrist gives you a titration schedule you can discuss the reasons for it but you still must follow it.

[Twelvesgirl]

Right, I agree. Like I've said before, trust in my doctors has come hard before, and now w/ wanting to be stable, trusting them is key, and trusting myself to know when I'm feeling bad is key. I don't want to feel bad anymore. I've researched everywhere, asked you probably a MILLION questions right?!!! I called or emailed my doc every day for the first week because of s/e, but that was from Risperdal, now that I'm off that **** and just on Lamictal and Topamax I'm fine. I also read that Lamictal can sometimes worsen mania but that can be treated w/ Lithium or Topamax. I'm already on Topamax for Migraine Aura, so we figured it should be a good fit. I hate meds and would rather go back into denial and off meds, but that means in a couple years, maybe sooner who knows, I'll fly away again into another world, and maybe physically too, and I can't afford that. I have a family and need to stabilize, I love them too much and need to stabilize and would love to recover. I need this.

TO cowgirlnerd:
I hope that I didn't come off as b****y in my first note, I read over it again, and thought that maybe I had. I didn't mean to at all. I read my very first one and I hadn't said that I had been diagnosed 3x over, I apologize for that, and have a tendency at typing fast and using words that type out rude-ish maybe? Like ILADVOCATE said about the FDA thing that says the dosage can't go above 25mg/wk, the docs are supposed to cover their A that way. I don't have much to say about the FDA, they made B6 that is found in fish to where you can't buy it in vitamin form anymore or some **** like that....so. They're not my favorite!

Anyhow, I was having a bad day yesterday, very angry day, I apologize.

[cowgirlnerd]

I didnt think you were being that way.  I have just been down so my answer was short and sweet.  No worries.  

Hope you feel better soon!