Posted by Patient on March 30, 2004, at 21:51:39
In reply to Re: Depakote dosage questions » HMK, posted by Ritch on April 16, 2002, at 12:51:23
~~~~"I'm currently taking Effexor XR 75 mg, Neurontin 400 mg three times daily, Geodon 60 mg twice a day, and Valium as needed. As I've stated before on these boards, I'm bipolar II and have recently been having trouble with rapid cycling.
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~~~~I am thinking that Depakote would be a good idea (I've tried it before and gained a ton of weight)but don't want the side effect of weight gain. How low of a dose could be effective without weight gain? Is it even possible to take this stuff without gaining? I'm 100 lbs overweight now and can't afford to gain more- was considering Topamax but I'm studying to take the bar examination so I can't be dealing with brain fogginess. Have already tried Tegretol/Trileptal.
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~~~~Your imput is sincerely appreciated.
~~~~Best wishes,
~~~~ Heather
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>
> "Hi Heather,
>
> I *clearly* gained an easy 20+ lbs. on 500mg/day. I noticed *some* weight gain (a few pounds) on 250mg/day. You might squeak by without any noticeable weight gain on 125mg/day. Some of the "weight gain" I have on it really is edema (swelling-water retention). With your other meds it might work, who knows? Some of the weight gain on Depakote isn't all metabolic slowing-some of it is reduced hyperactivity and agitation (relief!), as a result of taking it-and yes the munchies. If you can avoid taking it in the morning-daytime and take it after you have eaten dinner in the evening up till bedtime might help.
>
> Mitch"Hello all,
I've been taking 40mg Celexa daily, and 250mg Depakote Controlled-Release twice a day for anger discontrol problems (I have Borderline Personality Disorder and/or BiPolar 11). I have been taking this combination since the end of January '04. Prior to this I had just increased from 10 to 20mg Celexa, 25 to 12.5mg trazodone for sleep, and carbamazepine for anger disontrol/irritability. Last year I was taking 5 and 10mg Lexapro with 200mg carbamazepine for a several months-didn't like Lexapro (seemed weak and caused me agitation-neck stiffness-anorgasmia), and didn't like carbamazepine (Tegretol) both times I tried it-gave me indigestion, felt like cotton in stomach-false hunger pangs. Also caused water retention-swelling and did nothing for irritability. Doctor said I wasn't taking enough. "Sorry Doc, can't get past these digestive upset problems."
My problem is with my doctor's session last week. I told him that I've been doing very well on the 40mg Celexa daily, and twice dosing of 250mg Depakote C-R. I sleep good (no more need for trazodone), feel more at ease with everything, very little apathy, no zombiness, and have no side effects to complain of (can still have orgasms, have had no weight gain, actually lost about 5 pounds-no hair loss, no munchies). The only side effect I noticed is after starting Depakote I could faintly smell the scent of Limburger cheese or valerian root in my nostrils when I'd breath in-mainly after bedtime after arising to go pee or go out to retrieve some firewood for our wood stove. This was the first time in a long time I wasn't fiddling with my dosage to help save costs, or to reduce side effects, or to see if I could get better results by taking less. I told my doctor the only complaint was the cost, and that my husband reminded me of it every month when we'd go to the local pharmacy.
My doctor then said that the Depakote couldn't be doing anything for me since I wasn't taking a high enough dose. He said it was probably a placebo effect at best. He said, "now I'd like to experiment with you", and said he'd like me to drop down to 250mg Depakote C-R instead of 500mg, and eventually stop it alltogether; and to reduce to 20mg Celexa daily, then increase to 40mg for one to two weeks prior to my period (when my irritability would be at its worse), then reduce back to 20mg for rest of month. Well, I kinda fumbled and was surprised at what he was suggesting, since I was doing so well.
The mind reader I am, I figured he was wanting me to reduce dosages to save me money. So, I told him I'd like to get my prescription filled from Canada (I had the paperwork in hand-he had allowed me to order from Canada two years ago for bulk quantities of Prozac, Buspar, Celexa, and trazodone.) He didn't look at it, mentioned 20mg Celexa again, and I corrected him and said 40mg, which he talked over me as he wrote out my prescription as he wanted it, and out the door to his wife the office manager/receptionist I was sent. I told him I'd like to have the prescription for 3 months, since I'm doing well, and he agreed to let me see him in 3 months, instead of the usual two months. At that moment my short rushed session was over; I didn't even get any helpful suggestions when earlier I told him about the fear attacks I get with certain situations-mentioned I had a panic attack about 3 weeks ago-he just seemed like he was having a bad day, or had no time for me.
I understand the the Depakote literature for control-release form and/or regular form is to start patient at 750mg taken in divided doses, then increase until a certain divalproex sodium blood level is reached. I've read about doctors trying to figure out the dosage to increase to besides the blood level test is to take the person's weight, round it off to the nearest quarter (I think?), add a zero, and that is the recommended dosage you should work up to after your starting dose of 750mg. So for me, that would be 1,250mg a day in divided doses, since I weigh 117 stones/pounds. When I told my doctor this-he looked at me strange. (He tells me I shouldn't read about that stuff on the internet-"That's scary stuff" says he. I tell him I find it interesting. He'd never heard of figuring out the dosage that way, but he didn't tell me what dosage to take, either. I only know he gave me several samples of Depakote C-R 250mg for a trial one month period-telling me that there wasn't enough there for a high enough dosage for one month. That is how I started taking 250mg daily, then within two days started taking it twice a day until now. I was able to have the 'script filled once, and on the bottle it says take one to three tablets as directed-qty 90. I'm just confused here. Is the dosage guidelines the same for anger discontrol as it is for mania?
Long story I know, but what is the recommended dosage for anger discontrol? Is the 500mg Depakote all in my head? I think not, because for the past seven days I did reduce to 250mg, and I no longer sleep good, I'm back to having disturbing dreams, and get irritable more easily. I have worry thoughts during evening and awake at 2-4 in the morning worrying, can't go back to sleep. This was all made worse when later in week I did as suggested and reduced to 20mg Celexa-all to appease my doctor-give it a try. Well, it isn't worth it. et my prescription corrected by the doctor who is only in for one week a month-other weeks he goes to two other outlying towns for patients. In the past two days I've started taking .5mg lorazepam to help relax me in evening and help me sleep. Tomorrow I see my doctor to hopefully have my prescription rewritten for 40mg Celexa daily and 250mg Depakote twice daily. He's only in the office during a few days each month, which makes this problem even more frustrating. He's difficult to get a hold of. I would go to another doctor, but our budget is extremely tight-he's the cheapest in town.
The above post tells me that others are taking below the "drug manufacturers suggested dosage".
poster:Patient
thread:103226
URL: http://www.dr-bob.org/babble/20040329/msgs/330557.html