Q:  Is Trileptal a Safe Option for Son

My son, now 18, was diagnosed with ADD (Attention deficit disorder)when he was a young child but now his doctor has suddenly decided that he is probably bipolar and put him on a medication called Trileptal.  I wonder about the possible risks or side effects of this medicine. Is it safe for an 18 year old? Has it been in use enough to make any conclusions about its effectivenenss with bipolat disorder? 

BRIEF PRIOR HISTORY of our son:  He had some mixed results through the years with imipramine and then Adderal. However, even in the best case scenario, he had terrible sleep problems and his grades have been quite uneven. He had periods when he was taken off the Adderal (mainly because his weight would get so low) and then his moods would be all over the place, although he was never previously diagnosed with bipolar disorder. He does feel that the Adderal "blunts" his mood but when he is off it, he has trouble focusing in school. There is a family hisotry of depression and even manic-depression in some people but no immediate members of our family, except him, seem to be bipolar (although my mother, even at 90, is definitely ADD). I read with interest the coneection between thryoid medication and bipolar disorder. I am on thyroid meds and it does seem to help my mood.

I wonder where we go from here and whehter we should, indeed, try the trileptal. Is it a safe option? Also, is it safe to take Trileptal and Effexor? This, too, is an option, as he has anziety at times.


Dear Ms. C' -- 
You're doing good homework. I think Trileptal is perhaps one of our best current options and I'm impressed that your son's doc thinks likewise, apparently, as this medication is not even on the map of the current "first line" agents, but has rapidly risen to a close 2nd line choice (e.g in the Texas algorithms) and would be first line but for a lack of data on long term outcome (where the data for lithium are pretty good, and there's some data for Depakote, and otherwise that's it; so Trileptal is not really that far behind even in this respect). In case you haven't found it already, here's my basic info for folks on Trileptal, and my outline I use before starting it. 

By contrast, Effexor is in a completely different category of risk, because it is an antidepressant, which could make things worse.  I would not put it in the same sentence with a mood stabilizer, or speak it's name in the same breath, if you get my meaning there: very different proposition entirely, and as you can gather, it would not be in the running at this stage if I really thought the patient I was looking at had bipolar disorder. 

Good on ya' for your education you're pursuing. 

Dr. Phelps