Epilepsy and PMDD

[Tom46280]

My fiancee, a 37 year old woman, has had two grand mal seizures in the last 10 months.  In both cases she was unconscious for some time and was taken to the ER. She is not aware of any problems prior to these events.  She has had MRIs, CAT scans, EEGs, etc., and her Neurologist tells her she has "secondary generalized epilepsy", and prescribed Carbatrol and Neurontin. She has taken these drugs for several months and there have been no seizures.  Our immediate problem is this:  Several months before her second seziure her GYN had prescribed Sarafem (Prozac) 40mg/day for troublesome premenstrual irritability and anxiety (PMDD). This seemed to be helping this problem a few weeks after she began the Prozac.  However, since the second seizure her level of irritability, anger and anxiety have escalated; what was "PMS irritability" has become pretty quick rage, most of it directed at me at the slightest provocation.  She is aware of the the degree of change, and is bothered by this.  She does not seem to remember all the things she says when these events occur, and it's happening more frequently.  This problem is so bad that our relationship is in danger.  So, my questions are: (a)Is this change in temperment a result of the Carbatrol and/or Neurontin? Of the epilepsy? (b) Why is the Prozac no longer helping? (c) And, is there anything we can do?  Thank you for any help you can provide.

[CCF-Neuro-M.D.-CS]

The mood changes you are describing are not common side effects of carbatrol or neurontin. The only interaction between Carbatrol and Prozac is, Prozac may cause higher levels of Carbatrol within the blood. This can simply be followed by a blood level. Seizures can cause changes in personality, but unless there are frequent seizures, this is less likely.

If the diagnosis of epilepsy is new this may be a reaction to the diagnosis. It is not uncommon for individuals to develop a reactive depression from such a serious diagnosis. Depressive symptoms could include everything you describe.

Lastly, anytime there is a change in an individual after starting new medication (even though it may not be described) I think you have to consider the possibility it is a medication side effect. Therefore, you should discuss these issues with your neurologist. Also, if your fiancee has not been seen by a psychologist of psychiatrist it may be beneficial to at least have one visit to discuss the recent changes.

[mimisue]

Illness of any sort is very hard on a relationship.  Someone had the hindsight to install in sickness and in health in marriage vows probably of their own experience.  I am very sorry to hear you are dealing with this however you at least are given advance notice of what marriage is ultimately all about.  Committment.
You obviously love her as you have taken the time and consideration to look at her needs and comfort level.

If both of you have only recently become involved with the medical maze may I make the following suggestions.  Assuming you have not already done so.

Do not walk, RUN to the nearest university medical center. Call for an appointment with an INTERNIST.  I had very good luck checking with the office staff and finding out who they use.  I asked the appointment clerk, the referral clerk, and the nurses for a few of the doctors.  You can get a general idea of the DR.s disposition from the clerks and a practical idea of their areas of expertise from the nurses.  If you start at this level with your ?s you do not go in blind to your first consultation.  If you are not happy with this consultation try another.  It is easier to do that before you get on the test train.
Fortunately I was happy with the first Doctor, the key is do they ask intelligent questions and seriously consider your answers.

The internist is the jumping point to the proper specialist.  I have found that at university medical centers the Drs are more likely to consult with one another and your file and test results are onhand for all which greatly reduces duplication of tests and proceedures.  

Just reading your post reminds me of a Co-worker that had a grand-mal seizure last year, age 28, out of the blue.  Unfortunately it could not have happened to a nicer guy.  It started out with near fainting and then extremely radical behaviour, followed by unconsciousness.  The drs were comepletely at a loss and did all the tox screens, mri, ct, and a string of meds.  Through this course his splendid personality changed first vaguely then quite apparently.  Eventually he was diagnosed with an extremely high calcium level secondary to a malignancy.  

A high calcium level can result in such seizures as well as psychotic and rage behaviours, memory problems, and vague health complaints.  It can occur for several reasons including the overuse of tums.  

Though this may very well not be your fiance's problem, she is definately sick.  And all she needs is one well-meaning crack-pot telling her it is all in her head.  At the first sign of something like this leave.

I wish you both the very best of luck and health.

Mimisue

[Ohio_Grown]

I know exactly how you feel!  My fiancee is 22yrs. old and he has just recently been having seizures.  He just got out of the hospital a couple of days ago and since then he's been miserable.  While in the hospital, they ran a Cat Scan, MRI, EEG, EKG and still they have found nothing!  They have put him on Depakote, this medicine has made him so sick, tired, moody.  I know that he is scared (but of course he doesn't show it) and I believe that is what makes him so moody...the fact of not knowing what is wrong with him and what is causing it!  It has been very hard on me because it is as though he takes everything out on me now!  I know he doesn't mean to, but after a while it starts taking it's own toll on how I react to it.  We've had the best relationship and I'm scared to death that if he keeps treating me like this, that I'm going to have to let him go!  I know that is a terrible thing to even think!  I love him to death and I'd do anything for him, but I can only take so much!  I feel like I'm going to have an emotional break down because all he ever does is make me feel bad!  Don't get me wrong...I'm not trying to make this situation all about me...etc.  I know this is about him and being strong for him and helping him get through all of this!  But things need to change, for the last 2 weeks there hasn't been a night that I haven't cried myself to sleep just because he is treating me terrible.  He has never been like this in our relationship, he has always been great...I just don't understand why he takes it out on me!

[Tom46280]

I'm truly sorry someone else has to go through this ordeal, but maybe that means the medical community should give some thought to the problem we've discribed.  The key, at least to me, seems to be to find a doctor that will listen to the problem and address it, and that's been tough.  The GYN says she's not comfortable "tinkering" with the epilepsy meds and their effect, and the NURO has been a jerk, unwilling to even discuss the possible side effects of the drugs, or attempt to figure out the problem we have.  We have made an appointment with the NURO Dept. at the local university medical school and hope to find someone there who will listen, and be willing to work on this sudden change in mood and temperment.  I will report here on the result of our visit, (in mid October).  Perhaps you should also consider other opinions.  My own INTRN suggested that it was possible an experienced psychiatric specialist might be more familiar with the drugs involved and their interact, etc., since many of these drugs are being used for purposes other than epilepsy. (He also warned me that we should avoid a suggestion of "talk therapy" as a first solution.  He feels the change was so abrupt that it probably results from the epilepsy itself, or the medication.) So, we are also trying to find such a person.  I've found it is quite acceptable to call the shrinks office and state the problem, ask them if they have any experiences that may suggest an approach, etc.  So far, we've called three, all of whom thought this approach makes sense, but did not think they had made enough use of the two meds to be able to judge their effect in our situation, though they all suggested others that might, so we'll call them next.
   My hope is that you will not give up without first trying some other medical approach, and I sure hope we all find an answer.  I will post anything significant we find here, and I hope you'll do the same--hang in there, and good luck.