Q: Can Tegretol Make Someone Depressed?
Dear Dr. Phelps-
I have been diagnosed with Bipolar II Disorder. I currently take 40mg daily of
paroxetine. I understand the controversy in taking anti-depressants alone esp.
the case of Bipolar; however, when on mood-stabilizers in the past (Carbatrol,
Lamictal) I always felt I was kept stable but on the wrong side, i.e. kept
depressed. Therefore I elect with my doctor's approval and monitoring NOT to
them. But here's my question below:
I have a friend who takes about 1000mg daily of Tegretol to control his
He was in a car accident at 16 (he's 27) and since then has memory problems
(blackouts), dizziness and auditory hallucinations lasting about a half-hour
to a so-called seizure (when not medicated).
My concern for him is that he is depressed: stating he has little to no desire
food or sex, wishing he were dead, erratic sleeping patterns due to his
circumstances, feeling as though he has "too much pain" in his life, feeling
overwhelmed, low self-esteem, and crying spells.
He may have a family history (1st degree relative, now deceased) of mental
coupled with the head trauma in the accident --- IS IT POSSIBLE THAT THE
DEPRESSING HIM, as it did me (keeping me on the wrong side of normal)?
Thanks, love your site,
A researcher out there has been treating people with Bipolar II with
antidepressants alone and getting sustained good outcomes; his name is
Amsterdam, and here's his latest such report (Fluoxetine
2005). So there clearly is a precedent for what you're doing, and some --
Amsterdam and his colleagues, at least -- would be fine with this approach
Okay, that said, what of your question: can Tegretol
make someone depressed? I've definitely seen Depakote, another anti-seizure
medication we also use in bipolar, make someone depressed. I've seen that
several times. The person comes in cycling all over the place, and when we add
Depakote, the cycling stops -- but it's as though the Depakote takes away only
the high side of it all, not the low side, and the person comes back just
depressed, not cycling, just really down. I think this is less likely to happen
if we start Depakote more slowly, but it may be that some people just react to
it this way. Mind you (I'll get back to Tegretol in a moment), Depakote can also
sometimes have some pretty impressive antidepressant properties, so there is
clearly a lot of individual variation in how people react to medications like
As for Tegretol, I think it might be similar although I
have not seen a clear-cut case of depression developing on it, as I have with
Depakote. Instead, the people who do badly on Tegretol tend to get multiple
problems at once: they too can feel really badly, as do those who get depressed
on Depakote, but they feel sick as well as bad emotionally. They have nausea,
they just feel terrible all over. So perhaps depression could be in there too
but it is not obvious behind the physical symptoms. However, I've had people
emphasize how awful they felt on the stuff and I don't think they were talking
about the physical symptoms alone. Mind you, just as with Depakote, there are a
lot of people who think Tegretol is really great, extremely helpful, and who
have no side effects at all from it. Again, individual variation.
So, as it so often turns out when we're wondering if a
medication could be responsible for something a person is experiencing, the only
way to know for sure is to taper it off. Now please don't tell this fellow to
try this, or let him try to do this on his own: such a step must be taken with
his doctor's knowledge and participation. A back-up plan for symptom control
needs to be in place; sometimes another alternative medication started; before
the taper begins.
Does the head trauma add to the likelihood of his
depression being associated with Tegretol? Fair question; I don't know. Be
careful with how you frame this issue for him, okay? It could be that without
this medication he'd be having seizures or something else terrible, so for him
to start to associate it with depression, when it might be playing no such role,
would be very unfortunate in the long run. But it should be okay to ask and to
wonder, as you're doing here. Good luck with that.
Published March, 2006