Q:  Bipolar Disorder & Seizures

Would BiPolar cause intermittent seizures???  My friend seems to be having seizures.  Her doctor claims she is having seizures associated with BiPolar.

I do not believe this to be true.  She began these seizures when she began taking zoloft.  Is this the cause???  I do believe it is so.  Could it be due to high stress???  Please get back to me on this subject.

Tina
 

Dear Tina --

Let's start with a few pieces of information.

1.  Zoloft, like other antidepressants, "lowers seizure threshold".  That means that someone who has a tendency towards seizures, from a head injury for example, who does not have seizures routinely but is "close", can be tipped into having regular seizures when given Zoloft.  Many medications do this.

2.  "High stress" is of course rather difficult to define, but to my knowledge has not been shown directly related to their frequency of seizures.  Think of that person who has a tendency towards seizures, but is not having them routinely; can "high stress" type them into having regular seizures?  If "high stress" is associated with not sleeping well, then the "sleep deprivation" could definitely increase the frequency of seizures.  That is a well-recognized connection.  How about high stress but normal sleep?  Again, you can imagine how hard it is to separate these out on her research basis.

3.  It is bipolar disorder in itself associated with having seizures?  This one is a little more complicated.  There is certainly some sort of relationship between the two.  However, could a person who has a tendency toward having seizures, but his not having them routinely, began having them regularly when symptoms of bipolar disorder suddenly appear? To my knowledge, this has not been demonstrated  (note that this is a different question than simply asking whether or not people with bipolar disorder are more likely to have seizures than those who do not have bipolar disorder).

As for your questions, I hope the above information may prove useful, though it is not a specific "answer".  Very quickly, your questions become moot, as the focus must turn to treatment.  Since several medications used for bipolar disorder are "anticonvulsants", originally developed for the treatment of seizures, it does not require figuring out "bipolar versus seizures" -- one can treat both at the same time, not necessarily knowing exactly which one was the basis for the seizures.  Indeed, one particular option, lamotrigine, has recognized antidepressant effects as well as anti-seizure effects. 

May I add, however, a caution: be careful about how you proceed.  Many doctors do not react well when struck over the head with information.  I even composed a little essay on how to talk with doctors, to address this. Good luck with the process.

Dr. Phelps

Published April, 2008