Posted by Ritch on March 26, 2005, at 17:19:12
In reply to Re: Depakote successes with low side f/x? (ER better?) » Ritch, posted by cache-monkey on March 26, 2005, at 12:48:43
> Thanks for the input. I don't know if I'm going to go all that high on Depakote. My pdoc was all about pushing the dose on Lithium past where I was actually feeling stable b/c I was not in the therapeutic range yet. That ended up leading to diabete insipidus. (Slowly clearing up now that the Li has been removed.) Hopefully he'll be more conservative and go off my subjective experience after that...
Depakote has a much "flatter" dose-response curve than lithium does (generally). Keep in mind, that the blood levels for Depakote were first established for control of epilepsy, and the blood levels that were established for bipolar were for bringing down an acute bipolar I type manic reaction. Maybe you could remind your pdoc of that distinction... You are just looking for a maintenance dose and treating BPII which generally requires much less.
>
> But still, the hunger thing could very well be an issue. Even when I'm unmedicated, I can get pretty revenous. (Although when I'm undmedicated, my guilt/anxiety/repressed emotions lead me to ignore it, be hungry and miserable.)I get the munchies on it when I'm up at 500mg a day. If you can avoid taking it in the daytime that *does* help. If you can take ER and hopefully you don't need more than 500mg.. and take it hs, you won't have the munchies as bad. The primary advantage of taking the ER version is it smooths out the peakiness of the first few hours after a dose so you don't get as easily nauseated (if that's a side effect you get). It also makes it possible to dose once a day.. there are migraine folks that take two 500mg ER at once (1000mg) just once a day.
>
> If I end up adding an AD, I'm pushing hard for low-dose selegiline. I think dopamine's my thing, since I've been self-medicating with cigarettes for years. (Plus caffeine, which also turns on the DA-juice.)Sounds like a good idea.. The best thing I've found (that I've tried) to offset (not intentionally) the Depakote hungries was Ritalin. I've never tried selegiline. The anti ADHD effect sounds appealing to me though.
>
> Out of curiousity, what's your diagnosis? BP of some form? Or was the lithium/depakote added as an adjunct to "boost" the prozac? Oh, and one more thing: any hair loss for you?
>
> Thanks in advance,
> cache-monkey
>I'm rapid-cycling BPII with seasonal depressions accompanied by lots of anxiety. I've also had two pdocs tell me they were convinced I had comorbid ADHD as well. Lithium was my first antimanic for many many years along with low-doses of conventional antipsychotics (Mellaril or Thorazine), and later a benzo (primarily Valium or Librium). Just in the last few years I went off the lithium and onto Depakote, and on clonazepam. I've never had any significant hair loss with Depakote at 250-375mg/day. When I was at 500mg/day regularly, I did get some hair loss, but not much. I take Folic acid/zinc/selenium to help that. The L-Carnitine I take also, which Depakote can deplete. You might (if you can tolerate it), see about a small dose of Topamax to take with Dep. to offset hunger and possibly help with anxiety. The Top can make you pretty stupid, but some people really don't get that. I slept great on it-that's one thing I definitely liked. Hope this helps-- Mitch
poster:Ritch
thread:475448
URL: http://www.dr-bob.org/babble/20050326/msgs/475916.html