Psychotic from extended use of Depakote and/or Dilantin

[dz54]

My 25 yr old son is in an epileptic psychosis after 20+ years of epilepsy not being under control. He has loud, inappropriate outburst, conversations with imaginary people and is unable to control these things. He can talk from the time he gets up till he goes to sleep. It's difficult for him to be with others. Everyone thinks he is talking to them. He has little to do with me (his mother) and his father. Looks forward to being with his brother who just graduated from college.
He has been on many of the new anti-psychotic but they make him worse. Haldol works but lowers seizure threshold and make him fall.
We have good doctors who understand he needs gradual medicine changes because he is sensitive to medication even though he is 6', 250 lbs. Previous doctors have thought because he is big he can take mega doses and he can't. If you or your loved one is or has had these problems, please help.
We are really having a horrible time. Thanks for your time.

[Nakamova]

It sounds like too high a dose of Dilantin has produced the psychosis. Rather than piling on antipsychotics to treat the Dilantin problem, I would ask the doctors to consider easing up on his Dilantin dose (very slowly of course) to see if the psychosis lessens. And then perhaps consider a different anti-epileptic drug, again using a very slow transition time.

[PhylisFeinerJohnson]

Depakote was listed as a drug that could cause psychosis. http://www.wrongdiagnosis.com/p/psyc...on_causes_list

However, it's also used to treat the manic phase of bipolar disorders (manic-depressive illness).

Yet, conversely the side effects include: mood or behavior changes, depression, anxiety, agitatation, hostility, restlessness, hyperactivity (mentally or physically), and thought of self-harm or suicide. Is that connfusing or what? I guess the self-inflicted harm can come from the bi-polar disorder. http://www.drugs.com/depakote.html

Dilantin was only cited as possibly changing mental or mood changes. http://www.drugs.com/sfx/dilantin-side-effects.html

As one who was on Dilantin, I couldn't have even gotten up the energy to be "psychotic." I was a walking, talking zombie. But everybody is different, I know.

[dz54]

Thanks for your thoughts on this. It's exactly what I need. My son talks and is very articulate but not when answering questions about himself.
I forgot to mention that he is taking Celontin which is an older anti-epileptic drug that he has had some good luck with in the past (besides the Depakote and Dilantin). He also is on Ativan to help calm him somewhat but it doesn't control the outbursts.
Before I read your responses, we talked to his neurologist and we are bringing the Dilantin down. I hope that helps we are at our wits end on how to deal with him. He is in our basement right now howling and talking loudly like there was a party going on. I feel so badly for him because he has lost touch with reality. He wants to be doing what every one else is but the longer he stays to himself, the worse he gets.
Thanks for listening!

[PhylisFeinerJohnson]

My heart goes out to you...and him.

[RobinN]

I can only imagine what an emotional outburst with a 250 lb "boy" would be like.

I am only going to throw out this info, because it was never brought up to me.There is a connection between celiac disease and schizophrenia. It is possible that it isn't ONLY drug induced.

[dz54]

Thanks, but he was blood tested for celiac disease and it was negative and they continue to rule out schizophrenia because he sometime acts appropriately and does what he should be doing. He will get dressed when told to, goes to bed when told to, makes his lunch, etc. Sometimes 2 hrs. after he has his medication he acts up. The stuff he does is like clockwork which leads my husband and I to think the drugs are doing it. Also, any drugs that should help schizophrenia has just made him worse.
Thanks for the continued thoughts. It's just what we need because we hash his information over and over again and we need some fresh ideas and thoughts.
Oh, we also took him to a metabolic physician and he tested everything (because we thought he was too low or too high in something). Everything tested out normal. He had a spinal tap and all that came clear. He's been to Mayo and they sent him home saying keep on doing what you're doing. We have tryed to get him off all drugs and start again kind of like a rehab program but no one will touch us because of the epilepsy. Does anyone know of a place that could help us there. We know he needs epilepsy medication but we strongly believe he's on the wrong one and the only way to change quickly is in a place that would monitor him if he was in trouble. When he was younger we would just go to a clinic or hospital. Now it's not that easy.
Thanks.

[occb]

It is possible that the blood tests for celiac can give a false negative. It might still be worth it to eliminate gluten products from his diet to see how it affects him. Is the med-taking the only thing he does every morning, or does he have a specific routine for diet and activity in the morning?

Just to be sure -- he doesn't drink any grapefruit juice with his meds, does he? That can drastically alter absorption rates (increase it dramatically).

[jbishop]

Dilantin may induce Psychosis. Dilantin toxicity may not only present as Dementia. Because Psychosis is not a warning of side effects for Dilantin, Dilantin toxicity may be overlooked and the patient treated for psychosis with anti psychotic drugs without a satisfactory resolution. This happened to my mother and she spent 10 years in a hellish nightmare with the same symptoms you describe but for the last seven years of her life after we got her off the Dilantin her mental health was perfectly normal. It took about six months for her symptoms to completely abate after the withdrawl of Dilantin and during that withdrawl period she suffered at least one serious relapse. I switched her to Depakote and sent her to some different doctors to facilitate this change, based on my knowledge that her condition was Dilantin induced (despite her symptoms not conforming to that of the clinical definition for Dementia). The Depakote helped to ameliorate the Tardive Diskenesia caused by the Lithium, Stellazine and Haldol they used and which also destroyed her thyroid. I've written the FDA asking them to include Psychosis as a possible side effect so Dilantin toxicity isn't overlooked in such cases.

Here's a study that does show that Dilantin can cause psychosis:

From Website: ncbi.nlm.nih.gov/pubmed/14698717

Acute psychosis due to treatment with phenytoin in a nonepileptic patient.

Gatzonis SD, Angelopoulos E, Sarigiannis P, Mantouvalos V, Ploumbidis D, Siafakas A.

Department of Neurology, Eginition Hospital, Athens Medical School, 72 vas.Sofias av. 11528, Athens, Greece. satzon@med.uoa.gr
Abstract

The development of psychosis related to antiepileptic drug treatment is usually attributed to the interaction between the epileptic brain substratum and the antiepileptic drugs. The case of a nonepileptic patient who developed psychosis following phenytoin treatment for trigeminal neuralgia is described. This case suggests that the psychotic symptoms that occur following phenytoin treatment in some epileptic patients may be the direct result of medication, unrelated to seizures.

Here's another discussion:

From Website: livestrong.com/article/31041-dilantin-toxicity-symptoms/

Dilantin is a brand name of the generic drug phenytoin. This is an antiepileptic drug used to treat many different types of seizures. Toxicity can range from mild side effects to severe reactions and even death. Reactions tend to be worse with higher doses of the drug, but can occur at any level. Some adverse effects develop over time, whereas others may develop early on in therapy.

Nervous System

This is the most commonly affected system. Dizziness, loss of balance, headaches and slurred speech may develop. Confusion and nervousness can be seen. Nystagmus, an abnormal twitching of the eyeballs, can develop. Movement abnormalities like tremor, loss of coordination, and writhing or uncoordinated movements of the limbs may occur. All of these effects increase the chances of falling. Changes in sensation have been reported in those on Dilantin chronically. Long-term monitoring has raised concerns about the development of suicidal thoughts and behavior. Some patients may display psychosis or delirium. Lethargy or coma indicate severe toxicity.

Gastrointestinal System

Nausea, vomiting, constipation and abdominal pain can develop in those taking Dilantin. As the drug is metabolized in the liver, inflammation or damage to that organ can occur. Liver enlargement or hepatitis may be seen.

Skin

Rashes of various description may develop. These may resemble measles, blisters or other conditions. A potentially life-threatening condition known as Stevens-Johnson syndrome has been reported. This is characterized by redness, severe illness, fever and shedding of the skin. Enlargement of the lips or gums may develop over time with continued use.

Blood

Dilantin toxicity may be characterized by lowered counts of red or white blood cells or platelets, or all three. Some types of lymphoma, lymph node abnormalities and Hodgkin's disease have been seen. Dilantin has some effect on insulin metabolism and elevated blood sugar may develop.

Immune System

Inflammatory reactions, such as fever and joint aches may appear. There are reports of systemic lupus erythematosus developing in those taking Dilantin.

Cardiovascular

Decreases in blood pressure and/or heart rate may occur during intravenous infusion of the drug. The heart rhythm may also be disturbed.

Bones

Osteomalacia, or softening of the bones, may develop due to Dilantin's effects on vitamin D metabolism.

[dz54]

Thanks for your info. My son is very difficult at the moment. We give more anti-convulsants then he needs more ativan to calm down. It's a catch 22. We've tryed to decrease Dilantin before, it seems to be a good drug to somewhat control his many different types of seizures. We are trying to remove ativan as he has been on it a long time. His Doc would like to try Vimpat and remove depakote and dilantin. He has been on depakote & dilantin for most of his life. He talks but not about how he feels so i appreciate anyone telling me what these drugs feel like. Seizures never really have been completely under control for years so we're willing to try other drugs but he is very, very sensitive to drugs!!!!!

[Cint]

Dilantin may induce Psychosis.

Not only Dilantin, but other anti-epileptic drug's may also induce psychosis, according to a quote from this website:

http://professionals.epilepsy.com/pa...psychosis.html

Psychosis may be the expression of adverse effects of anti-epileptic drugs. The discontinuation of an anti-epileptic drug with mood stabilizing properties can also trigger a manic or psychotic depression in patients with an underlying mood disorder that had been controlled with that anti-epileptic drug.

Other causes of psychosis include substance use and withdrawal and primary psychiatric conditions such as brief reactive psychosis.

Is your son seeing a neurologist or an epileptologist? And is a neuropsychiatrist available in your area? A neuropsychiatrist would be more knowledgeable about issues your son is going through.

[dz54]

Started taking Vimpat the other day and it may be having an impact on the epilepsy. He seems to be better, thus we may be able to delete some Dilantin very soon. Can't wait!!!

[jbishop]

As studies have come to show that Dilantin may induce psychosis, I have filed a formal petition with the Food and Drug Administration, including an account of how this should not have been permitted to have ruined my mother's life and health.

Did you ever have the opportunity to wean your son entirely off Dilantin for six months to observe if at last the symptoms had gone away? There cannot be any other explanation for a mentally stable person to simply become completely psychotic -- unless you accept that a mentally healthy person becomes a raving psychotic without cause. The Dilantin is certanly a probable cause.