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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Bonnie_CA on February 7, 2008, at 5:20:32
Is it okay for a pdoc to prescribe Depakote as monotherapy for schizophrenia?
Posted by Maxime on February 7, 2008, at 10:49:50
In reply to Depakote for schizophrenia, posted by Bonnie_CA on February 7, 2008, at 5:20:32
> Is it okay for a pdoc to prescribe Depakote as monotherapy for schizophrenia?
I have never heard of it being prescribed for that. And I looked it up and it is not indicated for schizophrenia.
Is it possible that it's being prescribe for something other than the schizophrenia?
Oh wait, I just found an article on it. It doesn't recommend it. Here is the article:
A review of Valproate (Depakote) as a booster medicine for schizophrenia
Valproate as an adjunct to antipsychotics for schizophrenia: a systematic review of randomized trials.
Basan A, Kissling W, Leucht S.
Schizophr Res. 2004 Sep 1;70(1):33-7.This article takes a systematic look at the literature regarding the efficacy of using valproic acid (Depakote) as an adjunctive (additional to an antipsychotic) medication for schizophrenia. This medicine is a mood stabilizer and is typically a first line drug for treating bipolar disorder. However, it has properties that may make it useful in people with schizophrenia. It targets a neurotransmitter (chemical in the brain that turns on or off neurons or brain cells) called GABA which is a neurotransmitter that typically has a turning-off effect on brain cells. Some of these cells are involved in the production of dopamine which is a neurotransmitter that is associated, when in too high of a level, with the positive symptoms of schizophrenia (hallucinations, delusions, paranoia, bizarre thinking) and when in too little concentration, with the movement side effects seen with certain medications, like haloperidol/Haldol.
These authors searched the literature and came up with several articles that seemed relevant. Upon applying certain standards, five articles met the eligibility requirement to be included in the review and meta-analysis. (A meta-analysis is where the data from several studies are compiled together and analyzed as a group.) The results presented in this paper are equivocal at best. There are upsides and downsides to polypharmacy (the use of more than one medication to treat a particular condition.) On the one hand, the more meds you have someone take, the greater risk there is for side effects and drug interactions. Valproic acid has problems with weight gain and liver toxicity and that is true with other antipsychotics which can make for a problem. However, there is some minor evidence that valproic acid may help speed up the initial recovery of someone when starting or restarting them on antipsychotic medication. That can be useful if they only have a short time in the hospital and cannot afford to wait the couple of weeks to get full effect by the antipsychotic alone. However, the benefit wears out and was gone by the end of the study that showed this benefit, so it is unclear whether it means that the valproic acid should be continued or stopped after the acute situation resolves. Small trials have suggested that there may be a general decrease in negative symptoms (flat affect, constricted emotions, low energy, low motivation, poor hygiene) that is sometimes the most debilitating aspect of schizophrenia for many people. It does seem though, that valproic acid is useful in the case of schizoaffective disorder when there is a need for mood stability. It also seems to have a place for the aggressive or violent patient who has frequent outbursts and can benefit from some stabilization of their mood.
Overall, should you ask the doctor to start valproic acid for you or your loved one? Well, if they are already stable on medication, it is not something that they need to have. If they aren�t doing well, it might be worth a try to add it if there are no strong reasons to stay away from it (poor liver function, pregnancy or intent to become pregnant or history of weight gain or nonresponse to valproic acid.) The data currently is inconclusive to the benefit for valproic acid augmentation and therefore it is not possible to give a blanket recommendation one way or the other. However, if things are not working, it might be worth a try if it hasn�t been tried in the past.
Posted by Maxime on February 7, 2008, at 10:52:21
In reply to Re: Depakote for schizophrenia » Bonnie_CA, posted by Maxime on February 7, 2008, at 10:49:50
It is sometimes used to help with irritability in a patient with schizophrenia.
One thing for sure, it should not be mono therapy
for Schizophrenia.Maxime
Posted by Phillipa on February 7, 2008, at 12:33:38
In reply to Oh and ..., posted by Maxime on February 7, 2008, at 10:52:21
Just a thought are you positive they have schizophrenia maybe a psychotic episode of bipolar? Stil should not be monotheraphy. Just my thoughts no fact. Love Phillipa
Posted by Bonnie_CA on February 8, 2008, at 0:06:08
In reply to Oh and ..., posted by Maxime on February 7, 2008, at 10:52:21
Ok, I was just wondering, because I'm pretty sure that is what was going on with my uncle before he ran away and died alone in the woods. My uncle was a bonafide schizophrenic, and I asked my grandmother what his last medication was, and that's what the bottle said. I'm pretty sure it was a monotherapy, because there was no mention of multiple medications. I'm still pretty angry about it, because it's as if that doctor ignored a diagnosis that had been correct for 39 years (he was 56). November of 2006 he ran away without proper clothing on, and we'll never know how he passed away. His bones were found in December of 2006, and there is no evidence of foul play.
This is just an example of gross negligence on a doctor's part. I couldn't find any evidence that Depakote was good for schizophrenia either. My uncle wasn't the type to research or question anything. He has always done anything the doctor says. This was a new psychiatrist for him. I miss my uncle a lot, and I think it will be a long time before I find closure to this. It was one thing when my old pdoc prescribed Effexor and Prozac to me, because I am at least sane enough to understand what is going on. My poor uncle, he was very ill, and when he was off his meds, he didn't understand what was going on.
Thank you for your feedback. I guess I just wanted to know if someone else could find something about it that I couldn't, because as far as I could tell, it was completely wrong. I was bowled over when I found out what the medication was.
-Bonnie
Posted by Maxime on February 8, 2008, at 16:53:44
In reply to Re: Oh and ... *possible trigger?* » Maxime, posted by Bonnie_CA on February 8, 2008, at 0:06:08
I am very sorry about what happened to your Uncle. I wonder why he was not given the proper medications?
Again, I am sorry for your loss. No one should die that way.
Maxime
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