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Anticonvulsants

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Three Buzzing Conditions

The “three buzzing conditions” are epilepsybipolar disorder and migraine.The mainstream medical explanation for both epilepsy and migraine involve convulsions (seizures) triggered by abnormal electrical activity in the brain. In the case of bipolar disorder, the convulsive hypothesis has never been demonstrated to the (fortunately) high scientific standards of the biological psychiatry community, and there is actually a new field of exploration centering around neurotransmitters.

I’m not impartial. General hand-waving about neurotransmitters tends to irk me, as big pharma marketing has jeopardized the public image of biological psychiatry with oversimplified and sometimes flat out false theories like the “chemical imbalance” explanation for major depression. Actually, psychiatrists have known for a while that major depression results from neuron atrophy in the emotional center of the brain; while SSRIs make your brain marinate on serotonin, it’s not until they have been on your system for long enough to stimulate neuron regrowth that relief is felt.

Also, I am bipolar. I feel that bipolar disorder being closely related to epilepsy would erase much of the stigma. Some forms of epilepsy can trigger mood episodes, psychotic symptoms like hallucinations, derealization anddepersonalization crises and even automatisms, but those don’t get all the press that more common forms of epilepsy most characterized by tonic-clonic seizures do. Actually, from my symptoms the diagnosis of temporal lobe epilepsy was briefly considered, though EEG readings didn’t show anything.

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New cocktail

After a period of mostly funny (except when racing thoughts outpaced myself, rendering me semi-catatonic) hypomania, I sunk into a mixed episode with marked strong dysthimic moments — to the point I couldn’t get out of bed from depression this wednesday.

I think this stems from my shrink wanting to wean me off of Seroquel (I had been so stable on Seroquel and lamotrigine for so long), starting rippling waves even after I resumed my normal doses of Seroquel. Still, his project is to wean me off the anticonvulsants this time, substituting them for more Seroquel and more Ritalin (I take the long-acting version for actual ADD, not as a pick-me-up pill) to compensate for the extra sedative effects.

The extra Ritalin has also an emergency antidepressant function here. Higher doses of Seroquel are supposed to kick in with an antidepressant effect, but my functioning was way too impaired by the severe dysthimic micro-episodes I was getting at random points of time. All in all, while I’m worried about the possible “flattening” effects of getting too far with Seroquel (we’re dosing it up 50mg at a time), the extra Ritalin did give me an extra kick while not giving me the full hypomania (racing thoughts, etc.) effect. At least not yet.

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Recently been taking antipsychotics

All the drugs I’ve taken for most of my psychiatric life — except for that brief contact with bupropion — have been anticonvulsants. And I’ve actually been okay, oscillating between mild hypomania and no hypomania at all. Remember, I started psychiatric drugs because of depression, which hasn’t happened for more than a night or two since I started treatment.

Then somehow I got into the (hypo)mania that wouldn’t stop. I’d take 6 or 8mg of clonazepam and still be awake all night. Spending massive amounts of money in luxury stuff like $250 headphones or a 160gb iPod. So we finally entered the strange world of atypical antipsychotics. I had learned a lot about anticonvulsants, but this is brave new world to me.

For a while I though they were horrible drugs that silence the chatter inside your head. 1.5mg o risperidone made me smart — as in shutting out all other stimuli that made it difficult to concentrate on the smarter stuff. 2mg made me a bot.

We’re phasing risperidone now and introducing Seroquel. Like with risperidone I’m quite liking the effect — which is very different — but I’m not at the final dose yet. OTOH, I’m still on risperidone, so I might be on the right track regarding antipsychotics.

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