Anticonvulsants are used in the treatment of epilepsy and bipolar disorder, increasingly also for chronic pain (especially migraines and neuropathy). They include drugs with very different modes of action, but many of them are effective for sleeping problems, anxiety and depression.
Anticonvulsants can also relieve fatigue, flu-like symptoms, cognitive dysfunction (brainfog or "fibro fog"), neurological symptoms, irritable bowel syndrome (IBS), bladder problems, restless legs (RLS), muscle tension and multiple chemical sensitivity (MCS). Their ability to tackle many symptoms at once has made them one of the most important drugs in the treatment of CFS/ME and fibromyalgia.
Because anticonvulsants work by different mechanisms, their side effects vary too - obviously these depend on the individual and some people do not get any side effects. The older ones can very rarely cause liver problems and other severe reactions. On the other hand, the newer ones are more prone to causing sedation.
Headaches, dizziness and vision impairment are common side effects. Some anticonvulsants can cause weight gain, but a few (topiramate, vigabatrin and zonisamide) may lead to weight loss.
Gabapentin (Neurontin)
Gabapentin is one of the most popular treatments for CFS/ME and fibromyalgia. It can alleviate a wide variety of problems from interstitial cystitis to hot flashes. It is often used for anxiety and mood problems. Neurontin is also a popular pain treatment, especially for burning or electric shock-like neuropathy.
Pregabalin (Lyrica)
Pregabalin is very similar to gabapentin, but may be slightly better tolerated. Lyrica was the first FDA-approved drug for fibromyalgia, though there is no evidence that it is more effective in this use than the less expensive gabapentin. EMEA, the European equivalent of FDA, refused to approve Lyrica for fibromyalgia
Carbamazepine (Tegretol)
Carbamazepine is an old inexpensive anticonvulsant which has sometimes been used in CFS/ME. It is particularly effective for sharp and stabbing neuropathic pain. It can cause liver damage and other serious problems, so safer alternatives have mostly surpassed it.
Oxcarbazepine (Trileptal) is a newer derivative of carbamazepine with similar efficacy and uses, but it may be less likely to cause some of the serious adverse reactions.
Lamotrigine (Lamictal)
Lamotrigine affects many neurotransmitters and receptors in the brain. It also has some antiviral activity against HHV-6, a herpesvirus which has been associated with CFS/ME. Some people with CFS/ME have found it extremely useful.
Unfortunately lamotrigine can cause a life-threatening rash. This is very rare, but up to 10% of the patients develop some sort of a rash (usually harmless), so the drug is often discontinued just in case.
Levetiracetam (Keppra)
Levetiracetam may be the antidepressant with best tolerability and fewest side effects. It is often useful in RLS and migraine (especially migraine with aura). It may also help refractory cases of chronic pain and PTSD.
Clonazepam (Klonopin)
Clonazepam belongs to benzodiazepines, a class of tranquilizer drugs. It is sometimes used for sleeping problems and for its muscle relaxing properties. It is also an anticonvulsant. Many CFS/ME and fibromyalgia experts believe that in low doses clonazepam is one of the best treatments for these illnesses.
Other Alternatives
Topiramate (Topamax) is often used in migraine prophylaxis (prevention) and may also help neuropathic pain, but it is quite prone to causing cognitive impairment. Tiagabine (Gabitril) is good for anxiety and sleep and a preliminary study found it effective in fibromyalgia. Zonisamide (Zonegran) is currently being tried for the combination of fibromyalgia and migraine in a clinical trial.
References
Haavisto Maija. Reviving the Broken Marionette: Treatments for CFS/ME and Fibromyalgia. 2008.
Join the Conversation