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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by theo on May 26, 2005, at 22:23:58
I've been taking Depakote ER 250mg for a couple of weeks and it wasn't doing anything much and my doctor (not pdoc) said to go to 500mg and try it for 6 weeks.
Since being on 500mg for a few days, I've felt like doom and gloom and almost timid to be around people, like sad and ashamed. I thought this stuff was suppose to mellow you out? I did feel this slightly on 250mg.
My delima is, do I risk feeling this way in hopes these feelings (side effects) will pass? I sure as heck cannot handle this lower than heck feeling for 6 weeks. I'm taking no ther meds, just the 500mg Depakote ER.
I called my doc to report this, along with some mild soreness in my neck and between my pecks. I got a call back from the nurse saying "he just said to try it 6 weeks." Doctors amaze me sometimes, not even responding to my side effects.
I take it at 10:00pm and start to feel good the next day about 5:00pm. I don't know if the feeling good contributes to the Depakote ER working or simply the fact that it's wearing off!
Posted by Ritch on May 27, 2005, at 0:14:33
In reply to Depakote ER Question-Input Needed Please, posted by theo on May 26, 2005, at 22:23:58
> I've been taking Depakote ER 250mg for a couple of weeks and it wasn't doing anything much and my doctor (not pdoc) said to go to 500mg and try it for 6 weeks.
>
> Since being on 500mg for a few days, I've felt like doom and gloom and almost timid to be around people, like sad and ashamed. I thought this stuff was suppose to mellow you out? I did feel this slightly on 250mg.
>
> My delima is, do I risk feeling this way in hopes these feelings (side effects) will pass? I sure as heck cannot handle this lower than heck feeling for 6 weeks. I'm taking no ther meds, just the 500mg Depakote ER.
>
> I called my doc to report this, along with some mild soreness in my neck and between my pecks. I got a call back from the nurse saying "he just said to try it 6 weeks." Doctors amaze me sometimes, not even responding to my side effects.
>
> I take it at 10:00pm and start to feel good the next day about 5:00pm. I don't know if the feeling good contributes to the Depakote ER working or simply the fact that it's wearing off!
>
>
Peak anticonvulsant effects sometimes are different from the peak serum levels of the drug. I've heard this may be the case with Depakote and have read that even Neurontin has a peak anticonvulsant effect that is delayed several hours later from the peak serum level. That would imply some sort of a cascade mechanism being responsible rather than the drug itself. That all assumes of course, that peak anticonvulsant effects equate with peak therapeutic effects that you are seeking. The dose may be too high for your symptoms. Perhaps 375mg would be better?
Posted by theo on May 27, 2005, at 9:23:48
In reply to Re: Depakote ER Question-Input Needed Please » theo, posted by Ritch on May 27, 2005, at 0:14:33
I wish they made a 125mg ER to take 375mg. It's either 250 or 500mg with ER.
But are the side effects I mentioned common with Depakote ER and more importantly, will they subside with time?
Posted by Ritch on May 27, 2005, at 9:57:15
In reply to Re: Depakote ER Question-Input Needed Please » Ritch, posted by theo on May 27, 2005, at 9:23:48
> I wish they made a 125mg ER to take 375mg. It's either 250 or 500mg with ER.
>
> But are the side effects I mentioned common with Depakote ER and more importantly, will they subside with time?When I restarted it the last time about three years ago it was just 125mg at bedtime(added to existing meds-no switching). I noticed an improvement straight away with regards to agitation, etc. There was some cognitive dulling too, but that faded after a couple of weeks. Then I increased to 250mg/day (125mg twice daily) and got the cognitive sfx again.. but they also faded after a couple of weeks. However, when I push it to 500mg I feel better for a few days (with the cognitive sfx), but start getting too sleepy and hungry as well and back down on the dose. I need to get some 125mg tabs or sprinkle caps from my pdoc (they gave me samples before) and do 375mg at bedtime every other day (250mg eod) and see how that goes. I feel confident that if I could titrate up more slowly the sfx would be easier to tolerate. I think I need to be on a higher dose, but the jump from 250-500mg is too much at once. I also think there is a "sweet spot" where I get the best effects from it with limited side effects and I seem to pass that up at a steady 500mg/day. I don't like to take any of it in the daytime. The "gloom and doom" feelings don't sound too good. Depakote can be depressogenic. Is that the only med you're taking? You may also need an AD that you find non-agitating to take with it. You said your dx was Anxiety-NOS? Maybe Depakote isn't the best choice? Have you gotten a 2nd opinion?
Posted by cache-monkey on May 27, 2005, at 13:49:22
In reply to Depakote ER Question-Input Needed Please, posted by theo on May 26, 2005, at 22:23:58
I had virtually the same response to Depakote ER: I felt much more depressed and isolated. And it didn't do anything really for my anxiety/agitation. I also had roughly the same periodicity to my mood. I would start to feel better about 4-5 hours before my next night-time dose. I attributed this to the delayed peak in the drug concentration with the ER formulation. I.e. only after the drug level had peaked and fell below a certain point would I start to feel better.
When I complained that I thought it was making me more depressed, my pdoc told me to double the dose! Un-f-ing-believable. I felt even more depressed and isolated.
Out of curiousity, what aspect of your diagnosis led you to try Depakote? For me if I have BP, it is very soft. And I spend most of my time in depression/dysthymia, particularly so over the last couple of years. (My only true hypomania was anti-depressant induced.) Since Depakote is an anti-manic, I think it was a questionable choice for me without an antidepressant.
I've switched pdocs now, and we're looking at Seroquel (supposedly quite good for bipolar depression) and other possibilities.
Good luck,
cache-monkey> I've been taking Depakote ER 250mg for a couple of weeks and it wasn't doing anything much and my doctor (not pdoc) said to go to 500mg and try it for 6 weeks.
>
> Since being on 500mg for a few days, I've felt like doom and gloom and almost timid to be around people, like sad and ashamed. I thought this stuff was suppose to mellow you out? I did feel this slightly on 250mg.
>
> My delima is, do I risk feeling this way in hopes these feelings (side effects) will pass? I sure as heck cannot handle this lower than heck feeling for 6 weeks. I'm taking no ther meds, just the 500mg Depakote ER.
>
> I called my doc to report this, along with some mild soreness in my neck and between my pecks. I got a call back from the nurse saying "he just said to try it 6 weeks." Doctors amaze me sometimes, not even responding to my side effects.
>
> I take it at 10:00pm and start to feel good the next day about 5:00pm. I don't know if the feeling good contributes to the Depakote ER working or simply the fact that it's wearing off!
>
>
Posted by theo on May 27, 2005, at 14:11:44
In reply to Re: Depakote ER Question-Input Needed Please » theo, posted by Ritch on May 27, 2005, at 9:57:15
I've found with a lot of pdocs, there opinions are just that. In reality, it seems the only way to see what works is to try a med and if it doesn't work, move to the next. Two pdocs even said this to me which suprised me. I should have stayed in school a bit longer so I could get paid to guess and put patients through med trials.
Posted by theo on May 27, 2005, at 14:19:00
In reply to Re: Depakote ER Question-Input Needed Please » theo, posted by cache-monkey on May 27, 2005, at 13:49:22
Are you off Depakote ER now? I'm soft BPII if anything, so this was a stretch just to see how I would respond to it. Lamictal isn't very consistant and Topamax actually was similar to Depakote but 2x worse.
Posted by ed_uk on May 27, 2005, at 14:40:14
In reply to Re: Depakote ER Question-Input Needed Please » theo, posted by cache-monkey on May 27, 2005, at 13:49:22
Hi cm :-)
Do you think you might return to lithium at a much lower dose??? You might benefit from a very low dose without the severe side effects that you got from the high dose. Some people seem to do well on very low doses eg. plasma level 0.3.
Kind regards,
Ed.
Posted by cache-monkey on May 27, 2005, at 16:10:42
In reply to Re: Depakote ER Question-Input Needed Please » cache-monkey, posted by ed_uk on May 27, 2005, at 14:40:14
Hey Ed,
Wow, good memory! Although I guess my abnormal reaction to Lithium was pretty abnormal. Which seems to be the case with a number of meds :(.
Yeah, so the goal right now is to try Seroquel at a therapeutic dose (200 mg, since I'm slow in CYP-2D6) since that could help with a cluster of depressive/anxious symptoms. If that doesn't pan out due to somnolence, my new pdoc and I had been thinking of low-dose (2.5 mg) Zyprexa next.
Either way, that's a good point. Low-dose Lithium seemed to help a little. I woulnd't mind adding it back at a dose that doesn't make my kidneys freak out.
Still feeling like a bit of a guinea pig, though.
Best,
cache-monkey :)> Hi cm :-)
>
> Do you think you might return to lithium at a much lower dose??? You might benefit from a very low dose without the severe side effects that you got from the high dose. Some people seem to do well on very low doses eg. plasma level 0.3.
>
> Kind regards,
> Ed.
Posted by cache-monkey on May 27, 2005, at 16:22:33
In reply to Re: Depakote ER Question-Input Needed Please » cache-monkey, posted by theo on May 27, 2005, at 14:19:00
Yesterday was my last day at 250. At each dose reduction (from a peak of 1000) I felt a little less depressed. *Possibly* a bit of anxiety that I didn't realize was missing crept back in going down from 500 to 250. But I think that was more due to some stressful stuff going in my life.
I didn't like Lamictal at all. It ended up being really activating for me and precipitated an actual panic attack, which was a new experience for me. I have no experience with Topamax.
I really feel like I'd benefit from an anti-depressant. Since, without meds, I don't think I've experienced clinical hypomania. Mostly it's reactive depression/anxiety and a lot of dysthymia.
But the problem is that after an episode of hypomania on Celexa+Wellbutrin a few years ago, I can't go on an antidepressant unopposed.
My next plan is to try the atypical APs (possibly with low-dose Lithium). The first one I'm trying is Seroquel. I'm hoping I can get up to a therapeutic dose there without getting too sedated. I'm really hip on that idea due to the recent BOLDER study on Seroquel monotherapy for bipolar depression (in which they included BP II folks).
I sure with this process was quicker, though. I feel like I've been on the med-go-round for a while now with only a little overall improvement to show for it. (And that's mostly from therapy.)
BTW, Ritch mentioned this, but if you want to stick with the Depakote, you can go up in smaller increments using either the normal-release version or the "sprinkles" (which have some ER properties).
I'll definitely be interested to hear how things progress for you. Good luck!
Best,
cache-monkey> Are you off Depakote ER now? I'm soft BPII if anything, so this was a stretch just to see how I would respond to it. Lamictal isn't very consistant and Topamax actually was similar to Depakote but 2x worse.
Posted by ed_uk on May 27, 2005, at 17:34:18
In reply to Re: Depakote ER Question-Input Needed Please » theo, posted by cache-monkey on May 27, 2005, at 16:22:33
>Guinea pigs....
We all are!
Kind regards,
Ed.
Posted by cache-monkey on May 31, 2005, at 16:42:10
In reply to Re: Depakote ER Question-Input Needed Please » cache-monkey, posted by theo on May 27, 2005, at 14:19:00
So, I ended up feeling worse on no Depakote than I did on 250 mg (ER). A bit more agitated and anxious on none, and with 250 I don't feel the depression like I did at doses of 750 mg+. I'm experimenting with going back up to 500, but comes with annoying sexual side effects, and only a moderate additional decrease in agitation.
So for now I think I'll stick with 250 and add an occasional extra dose...
~cache-monkey
> Are you off Depakote ER now? I'm soft BPII if anything, so this was a stretch just to see how I would respond to it. Lamictal isn't very consistant and Topamax actually was similar to Depakote but 2x worse.
Posted by theo on May 31, 2005, at 22:52:37
In reply to Re: Depakote ER Question-Input Needed Please » theo, posted by cache-monkey on May 31, 2005, at 16:42:10
My doctor acts like there's a pot of gold if I wait six weeks on this. I left him a message stating the only way I can stick with Depakote ER is to add an antidepressant, because it is definitely making me sad as hell, till about 6:00pm, and then the clouds lift.
I myself dropped to 250mg tonight. My other problem is with Depakote ER at 500mg, I'm experiencing a scrathcy throat and fell like I'm coming down with an upper respiratory infection. I have had this experience with Lamictal and Topamax also. I wonder why anti-seizure meds do this to me?
Posted by cache-monkey on June 1, 2005, at 18:36:34
In reply to Re: Depakote ER Question-Input Needed Please » cache-monkey, posted by theo on May 31, 2005, at 22:52:37
Yeah, early evening was about exactly the time when the darkness dissapated.
I know that most anticonvulsants come with a common side effect of of rashes. (Not THE RASH, but more minor rashes...) So, maybe that's manifesting itself as your sore throat. It's supposed to be less common with Depakote, but I did notice a general (but minor) feeling of itchiness when I started it. And I experienced this with Lamictal, too, so I think this is how I get hit with the anticonvulsant-type rash.
~cache-monkey
> My doctor acts like there's a pot of gold if I wait six weeks on this. I left him a message stating the only way I can stick with Depakote ER is to add an antidepressant, because it is definitely making me sad as hell, till about 6:00pm, and then the clouds lift.
>
> I myself dropped to 250mg tonight. My other problem is with Depakote ER at 500mg, I'm experiencing a scrathcy throat and fell like I'm coming down with an upper respiratory infection. I have had this experience with Lamictal and Topamax also. I wonder why anti-seizure meds do this to me?
Posted by theo on June 5, 2005, at 23:11:37
In reply to Re: Depakote ER Question-Input Needed Please » theo, posted by cache-monkey on June 1, 2005, at 18:36:34
Are you still taking Depakote ER?
This is the end of the thread.
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