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Re: Serenics Rockel By

Posted by SLS on March 11, 2014, at 8:32:15

In reply to Re: Serenics, posted by Rockel By on March 11, 2014, at 6:00:44

Are we talking about hypomania?

Tegretol (carbamazepine) and Trileptal (oxcarbazepine) do work for aggression and impulse control. I have seen both of these drugs work in other people.

Each drug has its liabilities. Agranulocytosis and hyponatremia occur infrequently with Tegretol and Trileptal, respectively.

Tegretol: Periodic blood tests to screen for agranulocytosis.
Trileptal: Periodic blood tests to screen for hyponatremia.

Trileptal would be my choice. I was not at all sedated when I tried it. If sedation is desirable, Tegretol might make a better choice. These drugs probably work by stabilizing the temporal lobes.

Not very long after Zoloft was approved for use in the USA, doctors were using it to treat aggression. It seemed to work for some people. Tegretol + Zoloft was used sometimes. Unfortunately, in some people, Zoloft can produce akathisia and anxiety. The anxiety is likely to dissipate with time and can be controlled temporariliy with a benzodiazepine or doxepin. Akathisia is a profoundly intense reaction that is difficult to treat, although I have heard of the successful use of propranolol and benztropine (Cogentin).

As mentioned by Phidippus, lithium can be pacifying. I experience this with dosages above 450 mg/day. Unless you are bipolar, I would not make this my first choice, simply because it can be toxic on thyroid and kidneys at higher dosages.

- Scott


J Clin Psychopharmacol. 2005 Dec;25(6):575-9.
Oxcarbazepine in patients with impulsive aggression: a double-blind, placebo-controlled trial.
Mattes JA.
Author information

Impulsive aggression is a common clinically significant symptom, but there are few controlled studies evaluating drug treatment. This study evaluated oxcarbazepine in patients with impulsive aggression and whether diagnosis or other baseline characteristics predict response.

Eligible outpatients had clinically significant impulsive aggression, without other psychiatric symptoms clearly requiring treatment. Patients were randomized to oxcarbazepine or placebo, double-blind, for 10 weeks, at a variable dose increasing to 1200 mg/d if tolerated and to 2400 mg/d if aggression persisted. Primary outcome measures were (1) change in a Global Overt Aggression rating derived from the Overt Aggression Scale-Modified and (2) patient-rated global improvement.

Of 48 patients, 24 per group, 9 dropped out due to adverse events, but 45 completed at least 4 weeks on double-blind medication. Analyses showed consistent evidence of benefit from oxcarbazepine, compared with placebo, on both primary efficacy measures and most secondary measures. There were no significant interactions between diagnosis or other baseline characteristics and differential response to oxcarbazepine or placebo.

Oxcarbazepine appears to benefit adults with clinically significant impulsive aggression.


Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw




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