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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 theo on May 12, 2005, at 17:43:07
What is a fair length of time for trying Depakote (ER) before giving it up? I know SSRI's, TCA's are 4-6 weeks, but aren't anticonvulsants on a shorter timeline to know whether they are going to work or not?
Posted by linkadge on May 12, 2005, at 21:19:57
In reply to Length of time for Depakote (ER) trial?, posted by theo on May 12, 2005, at 17:43:07
If you still feel unstable after about 2 weeks I would say it is time to make some form of adjustment.
Linkadge
Posted by Ritch on May 12, 2005, at 23:09:10
In reply to Length of time for Depakote (ER) trial?, posted by theo on May 12, 2005, at 17:43:07
> What is a fair length of time for trying Depakote (ER) before giving it up? I know SSRI's, TCA's are 4-6 weeks, but aren't anticonvulsants on a shorter timeline to know whether they are going to work or not?
With Depakote I would look to see whether manic or "mixed" symptoms (ONLY) are being reduced short term (1-2 weeks) to determine whether it is "working" or not. If those symptoms aren't getting under control then I would either increase the dose or get on something else. Determining whether or not it is helping with "cycling" is more complicated. You would need to see if the next mood cycle was delayed or reduced in intensity and that might take a while if your cycles are longer than a couple of months or so. Looking at Depakote in terms of whether or not it is working with regards to anxiety or depression gets really murky, because it often may not help with a lot of those symptoms, and some people find that they are worsened by Depakote (i.e. anergic depressive states).
Posted by theo on May 13, 2005, at 0:00:39
In reply to Re: Length of time for Depakote (ER) trial? » theo, posted by Ritch on May 12, 2005, at 23:09:10
> > What is a fair length of time for trying Depakote (ER) before giving it up? I know SSRI's, TCA's are 4-6 weeks, but aren't anticonvulsants on a shorter timeline to know whether they are going to work or not?
>
> With Depakote I would look to see whether manic or "mixed" symptoms (ONLY) are being reduced short term (1-2 weeks) to determine whether it is "working" or not. If those symptoms aren't getting under control then I would either increase the dose or get on something else. Determining whether or not it is helping with "cycling" is more complicated. You would need to see if the next mood cycle was delayed or reduced in intensity and that might take a while if your cycles are longer than a couple of months or so. Looking at Depakote in terms of whether or not it is working with regards to anxiety or depression gets really murky, because it often may not help with a lot of those symptoms, and some people find that they are worsened by Depakote (i.e. anergic depressive states).Thanks, that's where I am. I wanted to see how it would effect me. I will say, I could see it being good for mania because I kind of feel flat. I will say, I've had no side effects like I did from others, mainly Topamax, which made me feel like something horrible was going to happen to me.
I do think a low dose of Depakote ER plus an AD or stim might be a good combo for me, but definitly not mono. I just finished reading a study on Depakote/Adderall XR combo that looked promising.
Posted by Ritch on May 13, 2005, at 9:50:35
In reply to Re: Length of time for Depakote (ER) trial? » Ritch, posted by theo on May 13, 2005, at 0:00:39
> > > What is a fair length of time for trying Depakote (ER) before giving it up? I know SSRI's, TCA's are 4-6 weeks, but aren't anticonvulsants on a shorter timeline to know whether they are going to work or not?
> >
> > With Depakote I would look to see whether manic or "mixed" symptoms (ONLY) are being reduced short term (1-2 weeks) to determine whether it is "working" or not. If those symptoms aren't getting under control then I would either increase the dose or get on something else. Determining whether or not it is helping with "cycling" is more complicated. You would need to see if the next mood cycle was delayed or reduced in intensity and that might take a while if your cycles are longer than a couple of months or so. Looking at Depakote in terms of whether or not it is working with regards to anxiety or depression gets really murky, because it often may not help with a lot of those symptoms, and some people find that they are worsened by Depakote (i.e. anergic depressive states).
>
> Thanks, that's where I am. I wanted to see how it would effect me. I will say, I could see it being good for mania because I kind of feel flat. I will say, I've had no side effects like I did from others, mainly Topamax, which made me feel like something horrible was going to happen to me.
>
> I do think a low dose of Depakote ER plus an AD or stim might be a good combo for me, but definitly not mono. I just finished reading a study on Depakote/Adderall XR combo that looked promising.
>
>I've been on Depakote + Adderall (plus a pinch of Effexor) in the past and it worked fairly well. Also Depakote + Ritalin seemed to work ok. I just get too much general anxiety from stims.. however I did notice that increasing the Depakote along with the stim helped to erase the anx without seeming to erode the benefits of the stim. Oh BTW, I had to stop the Keppra experiment-it was making me horribly irritable. I slept better and my working memory was much improved, but couldn't tolerate the irritability.
Posted by SLS on May 13, 2005, at 15:59:20
In reply to Re: Length of time for Depakote (ER) trial? » theo, posted by Ritch on May 13, 2005, at 9:50:35
> Oh BTW, I had to stop the Keppra experiment-it was making me horribly irritable. I slept better and my working memory was much improved, but couldn't tolerate the irritability.
Ouch. Irritability seems to be a common complaint with Keppra. Did it provide any antidepressant effects beyond the cognitive improvement?
- Scott
Posted by theo on May 13, 2005, at 16:59:54
In reply to Re: Length of time for Depakote (ER) trial? » Ritch, posted by SLS on May 13, 2005, at 15:59:20
> > Oh BTW, I had to stop the Keppra experiment-it was making me horribly irritable. I slept better and my working memory was much improved, but couldn't tolerate the irritability.
>
> Ouch. Irritability seems to be a common complaint with Keppra. Did it provide any antidepressant effects beyond the cognitive improvement?
>
>
> - ScottAlthough, irritability is dose related and didn't become a problem for me until I hit 1000mg/day. One thing about Keppra, which it clearly states in the PI, it doesn't accumulate so you know within a couple of days if you need to tweak the dose 250mg up or down. It is user friendly in that respect.
Posted by Ritch on May 13, 2005, at 23:57:34
In reply to Re: Length of time for Depakote (ER) trial? » Ritch, posted by SLS on May 13, 2005, at 15:59:20
> > Oh BTW, I had to stop the Keppra experiment-it was making me horribly irritable. I slept better and my working memory was much improved, but couldn't tolerate the irritability.
>
> Ouch. Irritability seems to be a common complaint with Keppra. Did it provide any antidepressant effects beyond the cognitive improvement?
>
>
> - ScottHi Scott, yes it did *seem* to provide some AD effects, but I think the improvement in working memory is what I'm associating the AD effects with. IOW, I don't feel like it had a "true" AD effect, just an opinion. I feel so much better now that I'm off it (friendly again and non-hostile). The whole idea of even taking it was simply to get me to sleep. It worked great for that. It also worked well for my restless legs that I've got. I'm beginning to think that my sleep disruption is an RLS symptom that *may* be aggravated by Depakote. I know, things are pretty complicated. The Keppra seemed to help the RLS, and helping "that" helped me sleep better and longer.. sleeping better and longer allowed my working memory to improve.. thus a seemingly AD effect (JUST MY THEORY). When I first quit the Keppra I went from sleeping 7-8 hrs. to just 4-5 hrs. right off the bat (and that's just stopping a 125-375mg dose per day). I felt sleep-deprived, fatigued, nasty memory, but... the irritability was fading. Another thing... I've had restless legs all along (mild).. and I've got family members with the same problem.. also family members with somnambulism and sleep talking.. but when I stopped the Keppra.. I realized that it was *helping* the RLS symptoms.. because some of my postures and constant fidgeting started up and I realized that I had been doing that all along and it was suppressed when I was taking the Keppra. So.. to get the needed sleep I just doubled up on antihistamine and added a little trazodone (25mg) at bedtime and I feel much better. I'm still a little dulled out.. but I don't feel hostile or grouchy.. if I can just get the sleep I need! -- Mitch
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