Tegretol:
Effects and Side Effects

1 Jun 04

I used to take Tegretol (carbamazepine) as an antimanic and as a mood stabiliser. Although I have become somewhat resistant to it as a mood stabiliser, it nevertheless remains the antimanic medication I use if I need to calm down NOW! It is however not particularly good as an antidepressant.

When I first start taking Tegretol it makes me sleepy. In fact it used to make me so sleepy that I had to restart drinking coffee just to get through a morning at work without falling asleep. But this effect fades in one to two weeks on the medication.

The most curious aspect of Tegretol is that when it first takes effect it allows me to do whatever I think I should do at what seems almost superhuman effortlessness. This is hard to explain, but basically if I think of something, I do it. No fuss, no bother, no effort.

It is as if my thoughts are on a railway line, crystal clear and channeled precisely in the direction I decide. My body then follows the direction precisely and immediately. I don't get sidetracked by distractions.

For someone like me who has difficulties keeping focused, this is a dream come true, and when in effect I call it my hyperstable mood. It is a like being manic, with all the energy and drive and charisma, without any of the problems of being manic. And I am calm and collected and the voice of sanity. As far as I am concerned this is better than the real normality.

Unfortunately, the effect, like the sleepiness, fades with exposure to Tegretol. It is however an addictive feeling and when I first started taking Tegretol, I would often stop taking the medication for a few days just so I could get this effect when I restarted.

Although the Tegretol works, the symptoms of the mania are always present. What Tegretol does is to calm me enough so that I can use my own capabilities to actively control the manic symptoms. I am the antimanic agent - Tegretol merely allows me to act in this manner. Under good conditions, I show can no outward manic symptoms, even though it remains an effort to do so.

However, if the manic episode is particularly strong, or if the dose of Tegretol is starting wear off, or if I start becoming resistant to the Tegretol, then it becomes an increasing effort for me to maintain stability. At such times it begins to feel as if a minor battle is going on in my head between keeping control and going manic and the battleground lines shift continuously as the mania gains ground now or loses it later.

I have to pay attention to the inward battle of damping down manic symptoms and thought patterns and at the same time maintain "normal" actions and appearance. When the manic episode is particularly bad, this can get truly surreal and I have often been terrified as I try to maintain my stability. Scared because I have difficulty concentrating on inward and outward actions at the same time, scared because I know I start becoming a little erratic to the people around me, and scared that I might lose any fragile hold on stability that I do have and the mania might win out.

At such times, I usually increase my medication to provide a little extra cavalry support, so to speak, much to the discomfort of my psych. I may increase the dosage each time I take the medication, or I may add in an extra dosage somewhere between my regular dosage times. The extra dosage is not without cost. At high doses (for me, 800 mg/day or 300mg at 5 hr intervals), Tegretol makes me muzzy headed and like a zombie. It is hard to think and I get nasty headaches.

Imagine trying to act normally in such a condition, much less fight an internal battle. But without the high dosage of Tegretol, I would have no control and I would destabilise. My choice was between a rock and a hard place. Or the frying pan and the fire. Or the Devil and the deep blue sea. Or no description and a cliché.

On the days when the hypomania threatened to go to mania, I would load up on medication and pray. I never knew in advance which would be worse, the side effects of the medication, or destabilising. And sometimes into the medication, I would almost have preferred going fully manic to being a zombie.

If I take Tegretol for about one month, I begin to build up a resistance to it. When this starts to happen, I would increase my dosage from 100 mg twice daily to 200 mg twice daily. That soon stops having much effect and I would then increase the dosage again, and if I continue, within four months I would be up to 800 mg per day. Since at 800 mg/day the side effects become fairly awful, I eventually chose to ask my psych to change medications rather than increase the dosage yet again..

Tegretol's effectiveness returns if I stop using it for about ten to fourteen days. But because I become resistant to it with time, I stopped taking it on a regular basis. However, it was while I was on Tegretol that I learned to distinguish between my "normal" self and my manic symptoms, and I have learned how to control my mania extremely well without any drugs.

Nowadays, I take it on an "as needed" basis at a 200 mg dose, if I feel the symptoms of mania resurfacing out of my control. When taken in this manner, it works on me extremely quickly - within twenty to thirty minutes it starts to calm the frenetic impulses and anxiety, makes me less twitchy, and settles my thoughts. I also occasionally take Tegretol about half hour before I start something stressful, such as giving a presentation or entering into a situation that is likely to be argumentative. And I take also occasionally take it before doing something that requires manual dexterity, such as servicing my bicycle.

By the way, my psych says Tegretol should not take effect as quickly as twenty minutes, but I have checked it over many occasions and the effect is consistent.

While taking Tegretol, I never got nausea, nor did it affect anything I wanted to do, provided I could stay awake. I did get the medicinal taste in my mouth on higher dosages, but I got used to that - it was my signal that the medicine was in my blood and working. However, I found out that when I was coming off Tegretol completely, I would get a really nasty throbbing headache lasting about three to four hours and usually rivalling the worst of my sinus headaches.

Tegretol also makes me almost immune to hangovers if I go drinking. But I have to be on Tegretol alone (I have gotten really nasty hangovers drinking on a Lithium / Epilim / Tegretol combination), and it doesn't work if I drink way too much.

 Tegretol also has very little effect on my depressive periods, but then again it is never marketed as an antidepressant.

Another View about Tegretol - 1
I started taking them [Tegretol] yesterday, and although my doctor told me it would take a week or so to take effect, it seems it has already taken effect.

Last night my partner and I noticed a distinct change in both my inward and outward appearance. All of a sudden I seemed to be able to concentrate fully on the moment. My usual state of mind could be compared only to watching 150 television sets all at once, yet understanding each television programme with relative clarity.

Although this sounds great to the average person, it is difficult to live with on a daily basis as you find yourself interrupting people when they talk to you due to having 20 responses to their last comment and should you dare to think of a single business idea, your mind kicks into overdrive and sends another 10 ideas in, just to confuse matters.

As I say, last night I suddenly became quieter, eerily quieter. The drug took over my motor responses, almost forcing me to look at my partner every time she spoke. Perhaps the strangest effect was when I tried to watch an interactive television channel. Normally I would look at this channel and concentrate on everything all at once, the 4 separate mini screens, the scrolling news at the bottom, the question of the day at on side. Not last night! Whilst my partner spoke to me, I found it impossible to concentrate on even one aspect of the screen, a very bizarre feeling. The most frustrating aspect, I found it impossible to interrupt my partner, my mouth obviously choosing to wait until she had finished speaking before it would let me speak.

Also, for about the past 10 - 15 years I haven't slept until about 3-4am in the morning. I tend to drop into bed, quite literally, rather than attempt to sleep. Again, last night, I simply had the urge to go to bed. I did and within 10 minutes, I was asleep!!...

...I fully understand the "superhuman" speed of working, because that is my usual state, unfortunately unappreciated by my previous employers (they did not believe I could complete an 8 hour working day in 3 hours and have the work done correctly).

I am slightly anxious about the effects it will have on me long term, especially considering the dramatic change in just a 24 hour period.

Another View about Tegretol - 2
I took 1600 mg/day of Tegretol for approximately four years but was taken off it because I became anemic [this writer is female]. I couldn't drink much alcohol while taking it without getting really sick - like vomiting sick. I also found Tegretol to be very sedating.

I'm taking 2000mg/day of Depakote now and notice a huge difference, and so have others who know me well. I have much more energy and enthusiasm for life, I wear brighter colors and generally have more hypomanic symptoms (yes, I still feel racy at times and have difficulty finishing tasks before starting other ones). Generally I like the Depakote much better. When I look back, while I was taking Tegretol I wore more earth tones and bland colors and had less interest in social things. People described me as "laid back." Now people would describe me more as "fun to be with and a workaholic."