TEGRETOL (carbamazepine)
Effects and Side Effects

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 speed. 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, and my body follows directions 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 without any of the problems of being manic. As far as I am concerned this is better than the real normality. I suspect it is akin to being high, although I feel calm and collected.

Unfortunately, the effect, like the sleepiness, fades with exposure to Tegretol. It is an addictive feeling and when I first started taking Tegretol alone, I often stopped the ongoing medication just so I could get this effect when I restarted.

I feel the effect of Tegretol on my hypomania in quite a different way from the effect of Epilim (Depakote, sodium valproate). Epilim makes the manic and depression feelings and actions fade and disappear so that I no longer have to think about them.

With Tegretol, I always have the symptoms of the mania. Tegretol calms me and opens the capability in me 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 no manic symptoms on Tegretol even though it is an effort to maintain the face of normality.

However, if the manic period is particularly strong or the Tegretol is starting to lose its effectiveness, 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 and at the same time maintain "normal" actions and appearance. This can get truly surreal and I have often been terrified as I try to do this. 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 dosage to provide a little extra calvary support so to speak, much to the discomfort of my psych. Then the world goes beyond surreal. 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 would 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 destabilize. 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 destabilizing. And sometimes into the medication, I would almost have preferred going fully manic to being a zombie.

After taking Tegretol for about one month, I began to build up a resistance to it, and I went from a dosage of 100 mg twice daily to 200 mg twice daily. That soon stopped having much effect and within four months I was up to 800 mg per day.

When the 800 mg/day dosage stopped having much effect, I asked my psych to change medications rather than increase the dosage. I was put on a Lithium / Tegretol combination which seemed to have no effect whatsoever, and much later on a Lithium / Epilim combination.

Although Tegretol's effectiveness returns if I stop using it for about ten to fourteen days, I no longer take it as my primary mood stabilizing agent since its effectiveness fades in time and because it had very little effect on my depressive periods. Nowadays, I take it on an "as needed" basis at a dosage of 200 mg every four hours if I feel the symptoms of hypomania resurfacing.

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, make me less twitchy, and settle my thoughts. My psych says this should not be happening - has anyone else gotten this effect? Send a note please.

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 headache, usually rivaling the worst of my sinus headaches.

One of the oddest side effects of Tegretol was that it used to make me almost immune to hangovers if I went out drinking. The one other person I know on Tegretol also says this is true. Has anyone else gotten this effect? The caveats for me were that I had 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. Comments on this would be appreciated.