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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Louisiana Sportsman on May 6, 2014, at 16:39:12
My hypothesis is that levetiracetam [Keppra; Keppra XR] may be underutilized and understudied as a medicament for patients, eminently schizophrenic and schizoaffective, tolerating cognitive deficiency from psychiatric medicament; ancillary, it may be an efficacious mood stabilizer indicated for bipolar patients that particularly respond to gabapentin/pregabalin's mood stabilization effect but not necessarily its anxiolytic effect.
While I do clarify my cognitive deficiency remedy in bulletpoint 1., I'd like to focus on my elucidation of levetiracetam as a potential mood stabilizer with properties similar to the gabapentinoids in bulletpoint 2.
1. Levetiracetam is the S-enantiomer of etiracetam, a structural derivative of piracetam. (via my very own analysis, the addition of ethylene to piracetam --> etiracetam, but I did not verify). It is subjacent to OTC piracetam for cognitive enhancement; however, in psychiatric conditions, such as schizophrenia and bipolar disorder, AEDs such as levetiracetam appear to have clear roles based on their effect on intracellular pathways. Levetiracetam is an effective treatment for patients with tardive dyskinesia (Drug Des Devel Ther. 2013 Nov 6;7:1329-40.) [I propose with concomitant cognitive deficiency]. Levetiracetam may be an alternative to OTC piracetam as a psychiatric remedy, but may be contraindicated for some patients and should be used with caution.
2. Levetiracetam displays mood stabilizing properties (Epilepsy Behav. 2004 Apr;5(2):204-15.), but it has not been well-studied. Clinical trials for gabapentin/pregabalin as mood stabilizers for bipolar disorder, particularly mania, have suggested that they are not effective. Au courant, some patients, including myself, have responded well to gabapentin/pregabalin for bipolar, and I propose that levetiracetam shares properties similar that may parturitate a beneficial outcome for bipolar patients such as myself that responded to gabapentin/pregabalin------
Gabapentin and pregabalin block P/Q-type VDCCs to reduce glutamate release, presynaptically (Eur J Neurosci. 2004;20:15661576). "Levetiracetam preferentially acts on P/Q-type VDCCs to decrease the amount of Ca2+ influx, reduce glutamate release and thus modulate synaptic activity in the DG." (CY Lee - 2009) The same quotation could be applied to gabapentin/pregabalin; they specifically effect the alpha 1A subunit; (Volume 1359, 4 November 2010, Pages 298303): in my own terms, levetiracetam acts on CACNA1A just like gabapentin/pregabalin.
The normal mood-stabilizing property action of levetiracetam as an AED combined with its action on CANA1A mimicing gabapentinoids make it a novel choice for patients who have responded to them.
A related medication that has experimental research for use in bipolar disorder with action on CANA1A is verapamil, but its actions are not very significant and essentially irrelevant, but still investigatory. Lamotrigine is involved with mutations on the receptor but is not as directly involved as verapamil and especially levetiracetam.
I propose levetiracetam to be studied as a psychotropic to be studied more extensively for cognitive deficiency and mood stabilization, espeically for patients who have responded to gabapentinoids.
Thoughts? Opinions?
Please share!
Posted by phidippus on May 7, 2014, at 14:31:17
In reply to Keppra Underrated AED nootropic similar to Lyrica?, posted by Louisiana Sportsman on May 6, 2014, at 16:39:12
I agree with you. Keppra has been instrumental in treating my OCD as well as being an effective mood stabilizer. Its a very clean drug to boot.
Eric
Posted by phidippus on May 7, 2014, at 14:36:48
In reply to Keppra Underrated AED nootropic similar to Lyrica?, posted by Louisiana Sportsman on May 6, 2014, at 16:39:12
Oh, and its nothing like Lyrica.
Eric
Posted by klein on May 8, 2014, at 7:14:36
In reply to Keppra Underrated AED nootropic similar to Lyrica?, posted by Louisiana Sportsman on May 6, 2014, at 16:39:12
> My hypothesis is that levetiracetam [Keppra; Keppra XR] may be underutilized and understudied as a medicament for patients, eminently schizophrenic and schizoaffective, tolerating cognitive deficiency from psychiatric medicament; ancillary, it may be an efficacious mood stabilizer indicated for bipolar patients that particularly respond to gabapentin/pregabalin's mood stabilization effect but not necessarily its anxiolytic effect.
>
> While I do clarify my cognitive deficiency remedy in bulletpoint 1., I'd like to focus on my elucidation of levetiracetam as a potential mood stabilizer with properties similar to the gabapentinoids in bulletpoint 2.
>
> 1. Levetiracetam is the S-enantiomer of etiracetam, a structural derivative of piracetam. (via my very own analysis, the addition of ethylene to piracetam --> etiracetam, but I did not verify). It is subjacent to OTC piracetam for cognitive enhancement; however, in psychiatric conditions, such as schizophrenia and bipolar disorder, AEDs such as levetiracetam appear to have clear roles based on their effect on intracellular pathways. Levetiracetam is an effective treatment for patients with tardive dyskinesia (Drug Des Devel Ther. 2013 Nov 6;7:1329-40.) [I propose with concomitant cognitive deficiency]. Levetiracetam may be an alternative to OTC piracetam as a psychiatric remedy, but may be contraindicated for some patients and should be used with caution.
>
> 2. Levetiracetam displays mood stabilizing properties (Epilepsy Behav. 2004 Apr;5(2):204-15.), but it has not been well-studied. Clinical trials for gabapentin/pregabalin as mood stabilizers for bipolar disorder, particularly mania, have suggested that they are not effective. Au courant, some patients, including myself, have responded well to gabapentin/pregabalin for bipolar, and I propose that levetiracetam shares properties similar that may parturitate a beneficial outcome for bipolar patients such as myself that responded to gabapentin/pregabalin------
>
> Gabapentin and pregabalin block P/Q-type VDCCs to reduce glutamate release, presynaptically (Eur J Neurosci. 2004;20:15661576). "Levetiracetam preferentially acts on P/Q-type VDCCs to decrease the amount of Ca2+ influx, reduce glutamate release and thus modulate synaptic activity in the DG." (CY Lee - 2009) The same quotation could be applied to gabapentin/pregabalin; they specifically effect the alpha 1A subunit; (Volume 1359, 4 November 2010, Pages 298303): in my own terms, levetiracetam acts on CACNA1A just like gabapentin/pregabalin.
>
> The normal mood-stabilizing property action of levetiracetam as an AED combined with its action on CANA1A mimicing gabapentinoids make it a novel choice for patients who have responded to them.
>
> A related medication that has experimental research for use in bipolar disorder with action on CANA1A is verapamil, but its actions are not very significant and essentially irrelevant, but still investigatory. Lamotrigine is involved with mutations on the receptor but is not as directly involved as verapamil and especially levetiracetam.
>
> I propose levetiracetam to be studied as a psychotropic to be studied more extensively for cognitive deficiency and mood stabilization, espeically for patients who have responded to gabapentinoids.
>
> Thoughts? Opinions?
>
> Please share!
>Hey L.,
Interesting analysis. I'm unfamiliar with Keppra but its side effect profile seems quite depressogenic. It's mechanism of action is pretty unique though. I never gleaned any benefit from nootropics but they do work wonders for some people.
Stahl seems to be crazy for Keppra, lol, lots of praise in (I'm trying this out) "Essential Psychopharmacology Prescribers Guide" "Binds to synaptic vesicle protein SV2A, which is involved in synaptic vesicle exocytosis" so it would be different from gabapentinoids. I noticed that Pfizer has two new drugs in that family in development (atagabalin and imagabalin - Wiki)
I guess Keppra joins the ranks of Zonegran, another AED with a unique (and mostly misunderstood) MOA. Apparently Zonegran is good for weight loss. I took it for a while and it gave me really nice sleep... it didn't sedate me, it just made sleep more enjoyable and restful.
Just my 2.
Posted by Beckett on May 13, 2014, at 0:52:26
In reply to Keppra Underrated AED nootropic similar to Lyrica?, posted by Louisiana Sportsman on May 6, 2014, at 16:39:12
Would Keppra help with anxiety as Lyrica does?
I did not follow all discussed, so the potential treatment of cognitive deficiency caught my interest.
Posted by phidippus on May 13, 2014, at 13:45:50
In reply to Re: Keppra Underrated AED nootropic similar to Lyrica?, posted by Beckett on May 13, 2014, at 0:52:26
Keppra has anxiolytic properties and has helped me with my OCD.
Eric
Posted by Beckett on May 13, 2014, at 14:13:17
In reply to Re: Keppra Underrated AED nootropic similar to Lyrica? » Beckett, posted by phidippus on May 13, 2014, at 13:45:50
Hi Eric,
OCD and GAD are different beasts, but maybe Keppra would help either.
Any reason not to try piracetam first?
Glad you are finding meds that work. How is your depression level?
Posted by phidippus on May 13, 2014, at 16:23:12
In reply to Re: Keppra Underrated AED nootropic similar to Lyrica?, posted by Beckett on May 13, 2014, at 14:13:17
> OCD and GAD are different beasts, but maybe Keppra would help either.
There is preliminary evidence about the efficacy of levetiracetam in the treatment of different psychiatric disorders, including anxiety, panic, stress, mood and bipolar, autism, and Tourette's syndrome.
but
The most serious adverse effects associated with levetiracetam use are behavioral in nature and might be more common in patients with a history of psychiatric and neurobehavioral problems.
Read: http://www.ncbi.nlm.nih.gov/pubmed/17685735
> Any reason not to try piracetam first?There don't seem to be any indications piracetam can be used to treat anxiety.
>How is your depression level?
I'm cycling due to the Brintellix, so some days I'm quite depressed. We stopped the Keppra and are now using Tegretol to control the mood.
Eric
This is the end of the thread.
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