Vagus nerve stimulation (VNS)

Overview

Vagus nerve stimulation involves the use of a device to stimulate the vagus nerve with electrical impulses. An implantable vagus nerve stimulator is currently FDA-approved to treat epilepsy and depression. There’s one vagus nerve on each side of your body, running from your brainstem through your neck to your chest and abdomen.

In conventional vagus nerve stimulation, a device is surgically implanted under the skin on your chest, and a wire is threaded under your skin connecting the device to the left vagus nerve. When activated, the device sends electrical signals along the left vagus nerve to your brainstem, which then sends signals to certain areas in your brain. The right vagus nerve isn’t used because it’s more likely to carry fibers that supply nerves to the heart.

Why it’s done

Device placement in vagus nerve stimulationVagus nerve stimulationOpen pop-up dialog box

About one-third of people with epilepsy don’t fully respond to anti-seizure drugs. Vagus nerve stimulation may be an option to reduce the frequency of seizures in people who haven’t achieved control with medications.

Vagus nerve stimulation may also be helpful for people who haven’t responded to intensive depression treatments, such as antidepressant medications, psychological counselling (psychotherapy) and electroconvulsive therapy (ECT).

The Food and Drug Administration (FDA) has approved vagus nerve stimulation for people who:

  • Are 4 years old and older
  • Have focal (partial) epilepsy
  • Have seizures that aren’t well-controlled with medications

The FDA has also approved vagus nerve stimulation for the treatment of depression in adults who:

  • Have chronic, hard-to-treat depression (treatment-resistant depression)
  • Haven’t improved after trying four or more medications or electroconvulsive therapy (ECT), or both
  • Continue standard depression treatments along with vagus nerve stimulation

Additionally, researchers are studying vagus nerve stimulation as a potential treatment for a variety of conditions, including headaches, rheumatoid arthritis, inflammatory bowel disease, bipolar disorder, obesity and Alzheimer’s disease.

Risks

For most people, vagus nerve stimulation is safe. But it does have some risks, both from the surgery to implant the device and from the brain stimulation.

Surgery risks

Surgical complications with implanted vagus nerve stimulation are rare and are similar to the dangers of having other types of surgery. They include:

  • Pain where the cut (incision) is made to implant the device
  • Infection
  • Difficulty swallowing
  • Vocal cord paralysis, which is usually temporary, but can be permanent

Side effects after surgery

Some of the side effects and health problems associated with implanted vagus nerve stimulation can include:

  • Voice changes
  • Hoarseness
  • Throat pain
  • Cough
  • Headaches
  • Shortness of breath
  • Difficulty swallowing
  • Tingling or prickling of the skin
  • Insomnia
  • Worsening of sleep apnea

For most people, side effects are tolerable. They may lessen over time, but some side effects may remain bothersome for as long as you use implanted vagus nerve stimulation.

Adjusting the electrical impulses can help minimize these effects. If side effects are intolerable, the device can be shut off temporarily or permanently.

How you prepare

It’s important to carefully consider the pros and cons of implanted vagus nerve stimulation before deciding to have the procedure. Make sure you know what all of your other treatment choices are and that you and your doctor both feel that implanted vagus nerve stimulation is the best option for you. Ask your doctor exactly what you should expect during surgery and after the pulse generator is in place.

Food and medications

You may need to stop taking certain medications ahead of time, and your doctor may ask you not to eat the night before the procedure.

What you can expect

Before the procedure

Before surgery, your doctor will do a physical examination. You may need blood tests or other tests to make sure you don’t have any health concerns that might be a problem. Your doctor may have you start taking antibiotics before surgery to prevent infection.

During the procedure

Surgery to implant the vagus nerve stimulation device can be done on an outpatient basis, though some surgeons recommend staying overnight.

The surgery usually takes an hour to an hour and a half. You may remain awake but have medication to numb the surgery area (local anesthesia), or you may be unconscious during the surgery (general anesthesia).

The surgery itself doesn’t involve your brain. Two incisions are made, one on your chest or in the armpit (axillary) region, and the other on the left side of the neck.

The pulse generator is implanted in the upper left side of your chest. The device is meant to be a permanent implant, but it can be removed if necessary.

The pulse generator is about the size of a stopwatch and runs on battery power. A lead wire is connected to the pulse generator. The lead wire is guided under your skin from your chest up to your neck, where it’s attached to the left vagus nerve through the second incision.

After the procedure

The pulse generator is turned on during a visit to your doctor’s office a few weeks after surgery. Then it can be programmed to deliver electrical impulses to the vagus nerve at various durations, frequencies and currents. Vagus nerve stimulation usually starts at a low level and is gradually increased, depending on your symptoms and side effects.

Stimulation is programmed to turn on and off in specific cycles — such as 30 seconds on, five minutes off. You may have some tingling sensations or slight pain in your neck and temporary hoarseness when the nerve stimulation is on.

The stimulator doesn’t detect seizure activity or depression symptoms. When it’s turned on, the stimulator turns on and off at the intervals selected by your doctor. You can use a hand-held magnet to initiate stimulation at a different time, for example, if you sense an impending seizure.

The magnet can also be used to temporarily turn off the vagus nerve stimulation, which may be necessary when you do certain activities such as public speaking, singing or exercising, or when you’re eating if you have swallowing problems.

You’ll need to visit your doctor periodically to make sure that the pulse generator is working correctly and that it hasn’t shifted out of position. Check with your doctor before having any medical tests, such as magnetic resonance imaging (MRI), which might interfere with your device.

Results

Implanted vagus nerve stimulation isn’t a cure for epilepsy. Most people with epilepsy won’t stop having seizures or taking epilepsy medication altogether after the procedure. But many will have fewer seizures, up to 20 to 50 percent fewer. Seizure intensity may lessen as well.

It can take months or even a year or longer of stimulation before you notice any significant reduction in seizures. Vagus nerve stimulation may also shorten the recovery time after a seizure. People who’ve had vagus nerve stimulation to treat epilepsy may also experience improvements in mood and quality of life.

Research is still mixed on the benefits of implanted vagus nerve stimulation for the treatment of depression. Some studies suggest the benefits of vagus nerve stimulation for depression accrue over time, and it may take at least several months of treatment before you notice any improvements in your depression symptoms. Implanted vagus nerve stimulation doesn’t work for everybody, and it isn’t intended to replace traditional treatments.

Additionally, some health insurance carriers may not pay for this procedure.

Studies of implanted vagus nerve stimulation as a treatment for conditions such as Alzheimer’s disease, headaches and rheumatoid arthritis have been too small to draw any definitive conclusions about how well it may work for those problems. More research is needed.

Living with hidden disabilities

In the UK alone, 1 in 5 people has a disability, with 80% of those having an invisible disability.

What is an invisible disability?

A person is considered to have a disability if he or she has difficulty performing certain functions (seeing, hearing, talking, walking, climbing stairs and lifting and carrying), or has difficulty performing activities of daily living, or has difficulty with certain social roles (doing school work for children, working at a job and around the house for adults).

Invisible disabilities, also known as Hidden Disabilities or Non-visible Disabilities, are disabilities that are not immediately apparent. Typically, they are chronic illnesses and conditions that significantly impair normal activities of daily living.

Living with these conditions can make daily life more demanding for many people. They affect each person in different ways and can be painful, exhausting, and isolating. Without visible evidence of the hidden disability, it is frequently difficult for others to acknowledge the challenges faced and as a consequence, sympathy and understanding can often be in short supply.

Examples of Hidden Disabilities
While this list is by no means exhaustive, some examples of hidden disabilities include:

  • Autism
  • Brain injuries
  • Crohn’s Disease
  • Chronic pain
  • Cystic Fibrosis
  • Depression, ADHD, Bipolar Disorder, Schizophrenia, and other mental health conditions
  • Diabetes
  • Epilepsy
  • Learning difficulties, including dyslexia, dyspraxia, dysgraphia, and language processing disorder
  • Lupus
  • Rheumatoid Arthritis
  • Visual and auditory disabilities. These could be considered visible if the person with the disability didn’t wear support aids such as glasses or hearing aids

During the COVID-19 pandemic, invisible disabilities have become a talking point, which is why it is important to raise awareness of them.

Epilepsy

Epilepsy is a common condition where sudden bursts of electrical activity in the brain cause seizures or fits. There are lots of possible symptoms of epileptic seizures, including uncontrollable shaking or losing awareness of things around you. The main treatment for epilepsy is medicine to help prevent seizures. It’s often not clear what causes epilepsy. Sometimes it runs in families or is caused by damage to the brain from trauma such as a severe head injury.

Useful Resources

Epilepsy bed sensor

Footprint GPS Alarm

Seizures and me: Charlotte’s story

Epilepsy Action – Free online course What to do when someone has a seizure

Epilepsy first aid poster

How we can help

Assistive technology can promote a sense of independence for those living with epilepsy, whilst providing peace of mind and reassurance for loved ones and carers.

Epilepsy sensors are used to monitor people with epilepsy while they are asleep in bed. Patented sensor technology detects a person’s movement in bed and is able to differentiate normal movements from epileptic seizures enabling tonic clonic seizures to be detected the moment they occur. They help carers respond quickly when needed, and avoid disturbing a person’s sleep when they are not. The sensitivity of the sensor can be adjusted to best suit the person’s requirements.

This sensor is suitable for use with children as well as adults.

Outside the home                                   

Our GPS falls detector recognises when a person falls and connects straight through to our alarm response centre – ensuring help is on its way when you need it most. The alarm can be set up to alert an emergency contact or we can request an ambulance right away – the plan can be tailored to your individual needs.

This is a great solution for teenagers or adults with epilepsy. In many cases a parent or carer for someone with epilepsy will undertake regular checks or need to be on hand 24/7. This means constant worry for the care giver and a loss of independence for the individual. Our Footprint device will automatically raise an alert if it detects a fall, (no need to press a button) as well as being able to locate where you are. This enables appropriate care to be provided quickly, without the need for manual checks. 

A Helping Hand

Our products and plans are tailor made to help you or your loved ones stay safe. Explore the range below and see how Progress Lifeline can assist those with Epilepsy.

Epilepsy bed sensor

These are used to detect seizures whilst in bed. They are able to detect movements that are associated with a tonic clonic type seizure.

Footprint GPS Alarm & Falls Detector

The Footprint is a GPS location device, pendant alarm & falls detector all-in-one.

Falls Detector

The Falls Detector can be worn as a pendant or as a watch. When a fall is detected, the device automatically connects the wearer to our alarm response centre – no need to even press the button.

Key Safe

A KeySafe can be installed externally to allow safe and secure emergency access to your home. (A code is used by contacts that you approve to help in an emergency).

Emergency Home Response

Add our Emergency Home Response service to any alarm package for just £11 per month. Our responders provide 24/7 assistance to you at home if your family and named contacts can’t get there.

  

Bipolar type one

Bipolar Type 1 is considered the most severe form of this illness.

According to the DSM 5, Bipolar I Disorder is characterized by one or more manic episode or mixed episodes (mixed episodes involve mania and depression) accompanied by episodes of depression alone (without mania or hypomania).

This is the most distinguishing, defining element of Bipolar I, (i.e. at least one truly manic episode).

A person may display psychotic symptoms such as delusions of grandeur or hallucinations.

In these cases, the condition is described as Bipolar Disorder I with psychotic features.

Bipolar I episodes of mania are so severe and debilitating that some experts use the term “raging Bipolar”.

A key point is “the symptoms are severe enough to disrupt the patient’s ability to work and socialize.”

Someone suffering from Bipolar I can have great difficulty functioning. You could have trouble holding down a job or maintaining a healthy relationship and typical, every day interactions with family and friends.1

Some symptoms you might experience during a manic episode include:

1. Decreased need for sleep.

2. Racing thoughts.

3. Pressured speech.

4. Excess energy or excessive hyperactivity.

5. Increased involvement in reckless or risky behavior.

6. Grandiosity or inflated self-esteem.

7. Becoming easily distracted or unable to finish one task or activity.

It is the tendency to become involved in risky or reckless behaviors that makes a manic episode the most dangerous to a patient. Driving carelessly, spending excessively and engaging in unsafe and reckless sex can have serious consequences that just do not matter to you at the time.

In a severe manic episode a person can lose all touch with reality. Left untreated a manic episode can last anywhere from a few days to several years of recurring episodes. Most of the time these symptoms will last for a few weeks or a few months.

The key difference between Bipolar I and Bipolar II is the presence of mania versus hypomania. It is important to understand this distinction in detail.

Bipolar I mania is often followed by a depressive episode. It can come within days or not pop up for several weeks or months.

During a depressive episode you may feel drained, in deep despair, guilty for no reason, worthless and irritable.

BP_Type_1

Activities you normally enjoy will hold no interest. You may experience sudden weight loss or weight gain and uncontrollable crying spells. At your lowest moment you may even have thoughts of suicide.

Again, possible consequences mean nothing to the afflicted person. These depressive episodes can last for years, which is why Bipolar I is often mistaken for chronic depression.

Many people with Bipolar I Disorder can enjoy periods where they don’t experience any symptoms in between episodes. These individuals are often able to go about their life, work, participate in family life, and socialize like anyone else. A minority of patients have rapid-cycling symptoms between mania and depression. In extreme cases symptoms of mania and depression can even alternate in the same day.2

Causes of Bipolar Disorder.

The exact cause of Bipolar Disorders is not precisely understood. It seems to be a combination of 3 things:

1. Genetics.

2. Chemical imbalances in the brain.

3. Stress and triggering events that somehow “activate” an inherited or genetic predisposition to the disorder.

Are Bipolar I and Bipolar II treated differently?

When you go for an assessment, just like with any other illness, you will be asked about family history. A close relative such as a parent with suspected or diagnosed bipolar disorder greatly increases the likelihood other family members also having the illness.

If you are concerned, take a Bipolar test.

So far, there does not seem to be any way to prevent the illness, but you can prevent some episodes of mania or depression once a doctor establishes that you do in fact have Bipolar I Disorder.

Bipolar I almost always requires the person to take medication for effective management. Don’t worry – stability and sanity is SO worth it!3

The key factor is stabilization. Regular therapy, a healthy diet, exercise and – MOST OF ALL – mood stabilizing medications such as
lithium can greatly reduce the frequency and severity of Bipolar I episodes.

Disability discrimination

What is a disability?

You have to show that your mental health problem is a disability to get the protection of the Equality Act.

‘Disability’ has a special legal meaning under the Equality Act, which is broader than the usual way you might understand the word. Even if you don’t think you have a disability, the Equality Act may protect you from discrimination if your mental health problem fits its definition of disability.

The Equality Act says you have a disability if you have a physical or mental impairment that has a substantial, adverse, and long-term effect on your ability to carry out normal day-to-day activities.

The focus is on the effect of your mental health problem, rather than the diagnosis. So you need to show that your mental health problem:

  • has more than a small effect on your everyday life
  • makes things more difficult for you, and
  • has lasted at least 12 months, is likely to last 12 months, or (if your mental health problem has improved) that it is likely to recur.

Examples of ‘substantial adverse effect’

Simon has obsessive-compulsive disorder (OCD). He has to check and recheck whether lights are switched off and doors are locked. This can make him late for work or other appointments. His obsessive thoughts often distract him from activities that he is doing and disrupt his daily routines. His mental health problem therefore has a substantial adverse effect on the way he does things.

Examples of ‘long term’

  • Jenny has had depression for 10 months and the doctor says it will be likely to last at least another 4 to 5 months.
  • Selina has bipolar affective disorder. She had her first and second episode in January 2013, then a third episode in January 2014. Even though there was a gap between her second and third episode, her mental health problem is considered to have continued over the whole period (in this case, a period of 13 months).

What if I’m getting medication or treatment for my mental health problem?

If you are getting some treatment or taking medication for your condition, you ignore the effect of your treatment when deciding whether your condition is having a substantial, adverse effect on your daily activities. This means the law is looking at how your condition affects you without your treatment or medication.

Example

Mohammed has long-term anxiety and is being treated by counselling. Anxiety would normally make him find simple tasks difficult. Because he has counselling, he is able to get up and go to work.

The Equality Act says you have to ignore his treatment in deciding whether his mental health problem has a substantial adverse effect on his day-to-day activities and so he has a disability.

What if I had a disability in the past?

You are still protected from discrimination if you had a disability in the past. That means that if your past mental health problem had a substantial, long-term and adverse effect, you will get the protection of the Equality Act.

Examples

Four years ago, Mary had depression that lasted 2 years and had a substantial effect on her ability to carry out normal day-to-day activities. She has not experienced depression since then.

If Mary is treated worse by her employer because of her past mental health problem, she will be protected by the Equality Act.

Checklist: Is my mental health problem a disability?

You can ask yourself these questions:

  1. Do I have a mental or physical health impairment?
  2. Is it long-term (meaning lasting more than 12 months or likely to do so)?
  3. Does it have a more than minor adverse effect on my day-to-day living, if I discount my treatment or medication?

If you answered “yes” to all three questions, then your mental health problem could get the protection of the Equality Act.

If you want to get the protection of the Equality Act, you may find it helpful to get some evidence from your GP, or another medical professional. You can ask them to write a letter saying whether they think you have a disability under the Equality Act. It would be particularly useful if they can give their opinion on the answer to each of these three questions.

Example

Esra doesn’t consider herself disabled because she doesn’t receive disability benefits and she is physically healthy.

Esra has been living with an anxiety disorder for the past 3 years. Because of this, it takes her a longer time to do things like get up in the morning, dress herself for the day and do the shopping. She takes medication to control the symptoms.

Esra would be protected by the Equality Act because she has:

  • a mental impairment – an anxiety disorder
  • it is long term – she has had it for the past 3 years
  • it has a substantial effect on her daily life – her mental health has a major effect on her daily life when you ignore the effect of her medication  
  • it has an adverse effect – her mental health problem makes things more difficult for her.

What are the different types of discrimination?

The Equality Act only protects people who have a disability against these types of discrimination:

It is possible that you have experienced discrimination in more than one way.

Direct discrimination

Direct discrimination is when you are treated worse than someone else because you have a disability. You have to show that there is a link between your disability and the way you have been treated, which can be difficult. However, you don’t always have to provide an example of a particular non-disabled person who was treated better than you if it is clear from all the circumstances that your disability was the reason why you were treated as you were.

Discrimination by association: you may be treated worse because of your connection or association with another person with a disability, even if you don’t have a disability yourself.

Discrimination by perception: you can also be treated worse because a person or organisation believes you do have a disability when you don’t.

Examples of direct discrimination

  • Jon is not offered a promotion because he has depression. But his colleague Harry, who does not have depression, is offered a promotion – even though he has less experience and fewer qualifications.
  • Carrie is interviewed for a job. She has better qualifications and more experience than all the other candidates, and performs the best at the interview. One of the interviewers knows of Carrie’s diagnosis of bipolar disorder. Carrie is not offered the job, but neither are any of the other candidates. Carrie hasn’t clearly been treated worse than any of the other candidates, but she has been treated worse than a non-disabled person would have been treated in the same situation.
  • Jenny is not offered an apprenticeship after she tells the training provider that she has caring responsibilities for her partner, who has a mental health problem. This is an example of discrimination by association.
  • A bank incorrectly assumed that David had a long-term mental health problem. They refused him a loan for this reason, even though he has no mental health problem. This is an example of discrimination by perception.

Discrimination arising from disability

This is where you are treated badly not because of your disability but because of something that happens because of your disability.

Unlike direct discrimination, there is no need for you to compare yourself with anyone else. You just have to show that you were treated badly, and this treatment was linked to your disability.

You don’t need to show that the person who treated you badly was aware that the behaviour was due to your disability, but they do need to be aware that you have a disability.

Examples of discrimination arising from disability

  • Peter experiences psychosis and hears voices, which he manages by talking to them. Staff in a shop ask Peter to leave when he is talking to his voices. Peter has been treated unfavourably because of behaviour related to his disability.
  • Jan is given a disciplinary warning from her employer for taking sickness-related absences because of her bipolar disorder. Her employer’s decision to treat this as a disciplinary matter may be discrimination arising from Jan’s disability.

Situations when unfavourable treatment might not be discrimination

There are some situations in which it might be lawful for a person or organisation to treat you unfavourably. These are if they can show that:

there were valid intentions behind their action (such as ensuring the health and safety of others, or keeping up staff attendance so that their business can run properly), and that it was an appropriate action to take in the circumstance (legally this is called a ‘justification‘), or
they did not know you had a disability (and could not reasonably have known).

For example, in Jan’s situation above, her employer might argue that the reason why they disciplined her was because they need to keep up staff attendance – therefore their action was justified. Jan might accept that her employer’s intentions were valid, but argue that the action they took was much too harsh and not appropriate in the circumstance – therefore their action was not justified.

Whoever is deciding whether or not unfavourable treatment is justified needs to balance the needs of both sides carefully, which can be very complicated.

Indirect discrimination

Indirect discrimination is where:

  • a person or organisation has practices or arrangements that seem to treat everyone in an equal, non-discriminatory way, but
  • these practices or arrangements put you and others with your disability at a disadvantage compared with those who do not have your disability.

Examples of indirect discrimination

  • An advice centre will only provide advice to people who visit their centre and will not offer advice by phone or email. This practice puts people with mental health problems like agoraphobia at a disadvantage because they can’t leave their homes to travel to the centre.
  • An employer only offers promotions to people who have a driving licence and are able to drive even though this is not a key requirement of the job. This will discriminate against people with mental health problems that prevent them from holding a driving licence.

For indirect discrimination, it doesn’t matter whether the person or organisation knew about your disability. This means they have to plan in advance and think about how their policies and practices may affect people with mental health problems.

But it is not indirect discrimination if the person or organisation can show these practices and arrangements were justified.

Harassment

Harassment is behaviour from others that you don’t want, that:

  • violates your dignity or creates an environment that is intimidating, degrading, offensive or humiliating, and
  • relates to a disability. It does not have to relate to a disability that you have.

Examples of harassment

  • Mary has an eating disorder. Mary’s manager knows she has an eating disorder and she makes offensive remarks in the open plan office about people with anorexia.
  • Steve has schizoaffective disorder. He is on a day out from inpatient treatment in a psychiatric hospital and is eating with fellow patients at a local café. A member of staff who knows he is a psychiatric patient uses silent gestures and mime to make fun of him. Steve is very upset.

Victimisation

Victimisation is when an employer or organisation puts you at a disadvantage just because:

  • you have made allegation about discrimination, or
  • you have supported someone who has made an allegation of discrimination

Examples of victimisation

  • Jibin’s colleague has bipolar disorder. Jibin supports her colleague to complain to their employer about disability discrimination. After this, Jibin’s manager refuses her promotion on the basis that her loyalty to the company is in question.
  • Deb has an anxiety disorder. She complains to her local supermarket that she genuinely believes that she has been discriminated against by an assistant who made remarks about her condition in front of customers. After this, the manager says she should shop elsewhere.

Making reasonable adjustments

The Equality Act says that employers and service providers should think about making reasonable adjustments (in other words, changes), if you are at a substantial disadvantage compared to other people who do not have a mental health problem.

Reasonable adjustments include:

  • making changes to the way things are organised or done
  • making changes to the built environment, or physical features around you (for example physical features of a building that put a disabled person at substantial disadvantage)
  • providing aids and services for you to overcome the substantial disadvantage.

You cannot be asked to pay for the cost of reasonable adjustments. If a person or organisation does not make reasonable adjustments when it would have been reasonable to do, this will be unlawful discrimination.

To find out more, see our pages on asking for reasonable adjustments from:

Examples of reasonable adjustments

  • Sylvie is working in an office and has depression. She is taking part in a supported employment scheme from the workplace mental health support scheme. Her employer lets her make private phone calls to her support worker in the working day as a reasonable adjustment.
  • Tomasz has a range of problems with anxiety, and he gets particularly anxious travelling on crowded public transport. He speaks to his manager about his mental health problem and explains that he is finding it hard to get to work in the morning travelling during the rush hour. Tomasz’s manager agrees to adjust his working hours so that he comes into work before the morning rush hour and leaves before the evening rush hour. His employer would not have to make adjustments if they did not know about Tomasz’s condition, or how it was affecting his working life.

Epilepsy – Carbamazepine/Tegratol

What is carbamazepine?

Carbamazepine is an anticonvulsant. It works by decreasing nerve impulses that cause seizures and nerve pain, such as trigeminal neuralgia and diabetic neuropathy.

Carbamazepine is also used to treat bipolar disorder.

Carbamazepine may also be used for purposes not listed in this medication guide.

Important Information

You should not take carbamazepine if you have a history of bone marrow suppression, if you are allergic to it, or take an antidepressant such as amitriptyline, desipramine, doxepin, imipramine, or nortriptyline.

TELL YOUR DOCTOR ABOUT ALL OTHER MEDICINES YOU USE. Some drugs can raise or lower your blood levels of carbamazepine, which may cause side effects or make this medicine less effective. Carbamazepine can also affect blood levels of certain other drugs, making them less effective or increasing side effects.

Carbamazepine may cause serious blood problems or a life-threatening skin rash or allergic reaction. Call your doctor if you have a fever, unusual weakness, bleeding, bruising, or a skin rash that causes blistering and peeling.

Some people have thoughts about suicide while taking seizure medicine. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

Do not stop taking this medicine without asking your doctor first, even if you feel fine.

If you are pregnant, do not start or stop taking carbamazepine without your doctor’s advice.

Before taking this medicine

You should not take carbamazepine if you have a history of bone marrow suppression, or if you are allergic to carbamazepine or to an antidepressant such as amitriptylinedesipraminedoxepinimipramine, or nortriptyline.

Do not use carbamazepine if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include furazolidoneisocarboxazidlinezolidphenelzinerasagilineselegiline, and tranylcypromine.

Carbamazepine may cause severe or life-threatening skin rash, and especially in people of Asian ancestry. Your doctor may recommend a blood test before you start the medication to determine your risk.

Tell your doctor if you have ever had:

You may have thoughts about suicide while taking carbamazepine. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Do not start or stop taking seizure medication during pregnancy without your doctor’s advice. Carbamazepine may harm an unborn baby, but having a seizure during pregnancy could harm both mother and baby. The benefit of preventing seizures may outweigh any risks to the baby.

Tell your doctor right away if you become pregnant.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of this medicine on the baby.

Carbamazepine can make birth control pills or implants less effective. Use a barrier form of birth control (such as a condom or diaphragm with spermicideto prevent pregnancy.

You should not breastfeed while you are using carbamazepine.

How should I take carbamazepine?

Take carbamazepine exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Take with food.

Swallow the extended-release tablet or capsule whole and do not crush, chew, or break it. Tell your doctor if you cannot swallow a pill whole.

The chewable tablet must be chewed before you swallow it.

Shake the oral suspension (liquid) before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and call your doctor promptly if this medicine seems to stop working as well in preventing your seizures.

You will need frequent medical tests.

Store at room temperature away from moisture, heat, and light.

Do not stop using carbamazepine suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor’s instructions about tapering your dose.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include severe drowsiness, weak or shallow breathing, and loss of consciousness.

What to avoid

Drinking alcohol with this medicine can cause side effects, and can also increase your risk of seizures.

Grapefruit may interact with carbamazepine and lead to unwanted side effects. Avoid the use of grapefruit products.

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.

Carbamazepine could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Carbamazepine side effects

Get emergency medical help if you have signs of an allergic reaction to carbamazepine (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (feversore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Seek medical treatment if you have a serious drug reaction that can affect many parts of your body. Symptoms may include: skin rash, fever, swollen glands, muscle aches, severe weakness, unusual bruising, or yellowing of your skin or eyes.

Report any new or worsening symptoms to your doctor, such as: sudden mood or behavior changes, depression, anxietyinsomnia, or if you feel agitated, hostile, restless, irritable, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

  • a skin rash, no matter how mild;
  • loss of appetite, right-sided upper stomach pain, dark urine;
  • slow, fast, or pounding heartbeats;
  • anemia or other blood problems – fever, chills, sore throat, mouth sores, bleeding gums, nosebleeds, pale skin, easy bruising, unusual tiredness, feeling light-headed or short of breath; or
  • low levels of sodium in the body – headache, confusion, severe weakness, feeling unsteady, increased seizures.

Common carbamazepine side effects may include:

  • dizziness, loss of coordination, problems with walking;
  • nausea, vomiting; or
  • drowsiness.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.Carbamazepine side effects (more detail)

What other drugs will affect carbamazepine?

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.

Using carbamazepine with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety, depression, or seizures.

Many drugs can interact with carbamazepine, and some drugs should not be used together. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. Tell your doctor about all your current medicines and any medicine you start or stop using.