Q:  L-carnitine & Mania?

Dr. Phelps,
I am a bipolar woman aged 31. My bp is type one and I also have OCD, panic, and PTSD.
My question is: is there any relationship between L-carnitine and getting manic? I take a mood stabilizer (Tegretol 1gr a day) plus a couple of ADs (Paxil 20mg and Zoloft 50mg) though none of the latter ever induced mania.  But L-carnitine (which I should take for a muscular partial deficiency)regularly does.

As I am also a MD, I would like to know which is the underlying pathogenesis of this. Thanks in advance



Dear Doc' -- 
With respect, how would you know, if you're taking Zoloft and Paxil and Carnitine with your Tegretol, and seeing cycling, which one was causing the cycling?  I.e. how would you know if it was carnitine, and not the antidepressants?  Perhaps you've already done the subtraction tests, and isolated the carnitine alone as the cause.  But since Zoloft and Paxil, not to mention the combination, are both associated with causing cycling, even if we hunted around the literature and found that carnitine was too, I'd still be worried about the antidepressants as playing a role. 

As for underlying pathogenesis, I try to keep up to date a page on my site addressing that topic, but I'm behind a bit lately.  There's new evidence of a mechanism adjusting genetic risk, called epigenetic modification (alteration of DNA transcription in one allele, like mom's, and not the other; potentially accounting for some of the odd patterns of inheritance sometimes seen).  I'll be writing that up soon, I hope.  But you can read what's there so far, which is pretty amazing as it is: etiology. 

Dr. Phelps