BLOG No. TWENTY TWO

Welcome back to my blog on anxiety and depression. I have to apologize to my readers. A few blogs ago I told you I was going to talk about side effects of the GABA-Glutamate balancing medicines. So I went to the doctor to find out if I possibly have ADD, but for some reason I didn’t pay attention to his answer.

All of the GABA-Glutamate balancers are antiepileptic (anti-seizure) medications. My favorite is probably Lamictal (lamictogene). It is what we call weight neutral (no weight gain) and is generally well tolerated. The only caveat regarding Lamictal is that in the original human trials, a handful of people broke out in a rash. At the time, the administrators were starting people at higher doses because the medicine was so side effect free. The FDA then I asked them to restart the trial ramping up the dose more slowly. The rash cases dropped dramatically. If any patient would start this medicine and get a rash (about 0.5%) they should stop the medicine and call the doctor.

Another medication I use a lot is Trileptal (oxycarbemezapine). It is also weight neutral and well tolerated. A small amount of patients feel a bit wobbly on it (about 3-4%). So those patients I will change to Lamictal. But where Lamictal needs 3-4 weeks to ramp up, Trileptal can be ramped up in around 10 to 12 days.

And then there are the occasional times I use Depakote (valproic acid). Depakote is the strongest of the three, but it can cause weight gain. The other thing it can cause it is elevated levels of ammonia, though it is rare. Those levels can easily be checked in the blood. I tend to use more Depakote in the patients that meet the criteria for bipolar disorder.

A cop pulls over a priest, who smells like wine. Seeing a nearly empty wine bottle on the passenger seat, he asks, “What have you been drinking, father?”

“Only water,” the priest answered. Smelling alcohol on his breath, the cop points to the wine bottle on the seat next to the priest. The priest uncorks the nearly empty bottle and takes a sniff.

“Wow, he did it again!”

So as always, I want to be transparent regarding these GABA-Glutamate balancers. Besides the side effects listed above, which are few, I want to speak of one more possible effect. Sometimes, patients can feel a little worse with their anxiety and depression before they feel better. Though it is usually only 5% or so, I’ve seen this phenomenon. But, I cannot explain it.

I also use the same medicines to prevent migraines, and sometimes patients suffer more headaches it first, until they get to the therapeutic dose. I encourage them in both cases, to try to hang in there and tough it out. Most do. Once they are at the targeted dose, relief comes, whether it is anxiety, depression, or migraines.

Well, I see that there is a fly in my Chardonnay. That might explain why Alanis Moressette was here. Until next time, this is Dr. G saying keep the faith!