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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 anon on September 17, 1999, at 1:32:47
After all drugs known to humankind I was still
feeling in the dumps, had a lot of trouble
concentrating, and to tell the truth felt suicidal,
so I threw my depakote away and felt a whole lot
better, perhaps overexcited, maybe even
mildly hypomanic, but still the best
in months. Now I took another of
the 250 mg tabs the doctor gave me for my "emotional
lability," according to her I'm not bipolar II, and
hey presto, I'm back to thinking about ending this farce.What gives, is it me or the depakote?
Posted by eh tu... on September 17, 1999, at 13:14:57
In reply to Does Depakote cause depression?, posted by anon on September 17, 1999, at 1:32:47
> After all drugs known to humankind I was still
> feeling in the dumps...
> What gives, is it me or the depakote?Probably both. The drugs suck, life sucks and hence we become anonymous as the combo. jointly sucks and as we become more anoymous to ourselve and others we disappear or wish to erase ourselves...
Posted by Susan Jane on September 17, 1999, at 22:17:53
In reply to Does Depakote cause depression?, posted by anon on September 17, 1999, at 1:32:47
Depakote didn't work real well for me because I had serious side-effects and wasn't able to keep real stable even at high doses. At one point when I was depressed for almost a week (I rapid cycle in the course of days if not hours) I tried Prozac and went into an awful mixed state with vivid suicide ideation. Anyway, I certainly was more on the depressed side with Depakote. I'm on Neurontin and very low does of Lithium and have been almost 100% stable for 4 weeks.
In answer to your last question, "...is it me or the depakote?" I'd guess both! :) Hey, these meds work differently for everyone. I'm playing the combo game now. Don't know how much you've done with that but the literature I've read says Bipolar II is better treated this way.
Good luck!
SusanJane :)
Posted by Carmen on September 18, 1999, at 20:09:25
In reply to Re: Does Depakote cause depression?, posted by Susan Jane on September 17, 1999, at 22:17:53
> Depakote didn't work real well for me because I had serious side-effects and wasn't able to keep real stable even at high doses. At one point when I was depressed for almost a week (I rapid cycle in the course of days if not hours) I tried Prozac and went into an awful mixed state with vivid suicide ideation. Anyway, I certainly was more on the depressed side with Depakote. I'm on Neurontin and very low does of Lithium and have been almost 100% stable for 4 weeks.
>
> In answer to your last question, "...is it me or the depakote?" I'd guess both! :) Hey, these meds work differently for everyone. I'm playing the combo game now. Don't know how much you've done with that but the literature I've read says Bipolar II is better treated this way.
>
> Good luck!
>
> SusanJane :)anon, Hi! I was on Depakote to stabilize my mood after being on Paxil for years. Paxil worked great, but I became manic which the Dr. thinks might have been a reaction to the Paxil for me. Depakote sucked! Left me totally unmotivated and was low-grade depressed all the time. Went off of it and felt much better. Now on Neurontin which for me has had no side affects, but has really helped. Carmen
Posted by chy on September 30, 1999, at 6:40:59
In reply to Re: Does Depakote cause depression?, posted by Carmen on September 18, 1999, at 20:09:25
Dep worked okay for me.
It slowed me down and just packed on those pounds, but it gave me focus. I actually sat down every day to write. Every now and then I think about going back on it just for that.
chy
Posted by gpm on September 4, 2000, at 0:07:39
In reply to Re: Does Depakote cause depression?, posted by Carmen on September 18, 1999, at 20:09:25
Does depakote cause depression? I dont know, you tell me. I have been on it for several months, gained a ton of weight, feel sick and dizzy all the time and I am on the web right now trying to find out how much of the stuff is a lethal dose because I dont want to live this way anymore. Top that off with the fact that my shrink never even bothered to have his office call me when he put me on the stuff as I was suicidal and in the middle of a divorce. I guess he found some other way to make the payments on his BMW. I hate depakote!
> > Depakote didn't work real well for me because I had serious side-effects and wasn't able to keep real stable even at high doses. At one point when I was depressed for almost a week (I rapid cycle in the course of days if not hours) I tried Prozac and went into an awful mixed state with vivid suicide ideation. Anyway, I certainly was more on the depressed side with Depakote. I'm on Neurontin and very low does of Lithium and have been almost 100% stable for 4 weeks.
> >
> > In answer to your last question, "...is it me or the depakote?" I'd guess both! :) Hey, these meds work differently for everyone. I'm playing the combo game now. Don't know how much you've done with that but the literature I've read says Bipolar II is better treated this way.
> >
> > Good luck!
> >
> > SusanJane :)
>
> anon, Hi! I was on Depakote to stabilize my mood after being on Paxil for years. Paxil worked great, but I became manic which the Dr. thinks might have been a reaction to the Paxil for me. Depakote sucked! Left me totally unmotivated and was low-grade depressed all the time. Went off of it and felt much better. Now on Neurontin which for me has had no side affects, but has really helped. Carmen
Posted by Wilkie on September 27, 2000, at 15:20:40
In reply to Re: Does Depakote cause depression?, posted by gpm on September 4, 2000, at 0:07:39
I have been on Depakote for Bipolar II treatment since May of this year. I have gained a good 25 pounds at least, am losing more hair than normal, and experience depression and lethargy and extreme fatigue. I take antidepressants to counter the latter symptoms. I was on effexor for a while but it was affecting my sleep (crazy intense dreaming) so i went off of it (went through brutal withdrawal by the way) and am now on wellbutrin for depression, which has also been shown to increase sex drive and induce weight loss. Since with Bipolar II depression is my primary problem I have found it necessary to have antidepressants, but I definitely experienced marked depression and fatigue when I started the depakote that subsided greatly when I went on an antidepressant.
Posted by SLS on September 27, 2000, at 21:55:29
In reply to Re: Does Depakote cause depression?, posted by Wilkie on September 27, 2000, at 15:20:40
> I have been on Depakote for Bipolar II treatment since May of this year. I have gained a good 25 pounds at least, am losing more hair than normal, and experience depression and lethargy and extreme fatigue. I take antidepressants to counter the latter symptoms. I was on effexor for a while but it was affecting my sleep (crazy intense dreaming) so i went off of it (went through brutal withdrawal by the way) and am now on wellbutrin for depression, which has also been shown to increase sex drive and induce weight loss. Since with Bipolar II depression is my primary problem I have found it necessary to have antidepressants, but I definitely experienced marked depression and fatigue when I started the depakote that subsided greatly when I went on an antidepressant.
Hi Wilkie.Have you considered using Lamictal as a substitute for Depakote? It is a mood-stabilizer that has antidepressant properties. It has been demonstrated conclusively to effectively treat bipolar depression. It is not sedating.
- Scott
Posted by Wilkie on September 28, 2000, at 22:22:16
In reply to Re: Does Depakote cause depression?, posted by SLS on September 27, 2000, at 21:55:29
> > I have been on Depakote for Bipolar II treatment since May of this year. I have gained a good 25 pounds at least, am losing more hair than normal, and experience depression and lethargy and extreme fatigue. I take antidepressants to counter the latter symptoms. I was on effexor for a while but it was affecting my sleep (crazy intense dreaming) so i went off of it (went through brutal withdrawal by the way) and am now on wellbutrin for depression, which has also been shown to increase sex drive and induce weight loss. Since with Bipolar II depression is my primary problem I have found it necessary to have antidepressants, but I definitely experienced marked depression and fatigue when I started the depakote that subsided greatly when I went on an antidepressant.
>
>
> Hi Wilkie.
>
> Have you considered using Lamictal as a substitute for Depakote? It is a mood-stabilizer that has antidepressant properties. It has been demonstrated conclusively to effectively treat bipolar depression. It is not sedating.
>
>
> - ScottScott -
My shrink told me about Lamictal as a future option if needed. He said it has to be started extremely gradually (2-3 months to reach a therapeutic level sometimes) because it can cause a deadly rash. This scares me and I would like to avoid it if possible. Also, I hate to think of what would happen to me in 2 months without much of a mood stabilizer. Any response to this?
Posted by SLS on September 30, 2000, at 1:07:21
In reply to Re: Does Depakote cause depression? » SLS, posted by Wilkie on September 28, 2000, at 22:22:16
> > > I have been on Depakote for Bipolar II treatment since May of this year. I have gained a good 25 pounds at least, am losing more hair than normal, and experience depression and lethargy and extreme fatigue. I take antidepressants to counter the latter symptoms. I was on effexor for a while but it was affecting my sleep (crazy intense dreaming) so i went off of it (went through brutal withdrawal by the way) and am now on wellbutrin for depression, which has also been shown to increase sex drive and induce weight loss. Since with Bipolar II depression is my primary problem I have found it necessary to have antidepressants, but I definitely experienced marked depression and fatigue when I started the depakote that subsided greatly when I went on an antidepressant.
> >
> >
> > Hi Wilkie.
> >
> > Have you considered using Lamictal as a substitute for Depakote? It is a mood-stabilizer that has antidepressant properties. It has been demonstrated conclusively to effectively treat bipolar depression. It is not sedating.
> >
> >
> > - Scott
>
> Scott -
>
> My shrink told me about Lamictal as a future option if needed. He said it has to be started extremely gradually (2-3 months to reach a therapeutic level sometimes) because it can cause a deadly rash. This scares me and I would like to avoid it if possible. Also, I hate to think of what would happen to me in 2 months without much of a mood stabilizer. Any response to this?
It is very infrequent that this rash-reaction appears when the dosage is titrated as prescribed by the PDR (Physician's Desk Reference). The reported incidence of serious rash in adults is one in one thousand. I imagine this statistic includes those people who did not follow the suggested schedule. I still hear of doctors bringing their patients up to 100mg within two weeks. In these cases, one can withdraw the Lamictal and restart it the right way successfully. In my humble opinion, I think your fear of Lamictal is not proportionate with the risks it actually poses.Lamictal can be added safely to Depakote. That is what this drug was developed for - as an add-on to other anticonvulsants to treat partial-seizure epilepsy. HOWEVER, the dosage of Lamictal must be reduced by half when it is combined with Depakote. Depakote slows down the rate at which the body breaks-down Lamictal.
Studies of Lamictal for bipolar depression demonstrate that it is effective. Some people respond to 50mg. However, the average effective dosage is around 200mg. I take 300mg.
Even though Lamictal is considered effective to treat mixed-state mania and rapid-cyclicity, I am not convinced that it is that potent as a mood stabilizer on its own. If you are at high risk of developing mania, and Depakote has worked well to prevent it, I would suggest keeping it. If, however, Depakote represents a failed attempt to treat depression, I think it makes sense to switch.
From the Glaxo - FDA advisory:http://depts.washington.edu/druginfo/Alerts/Details/Lamotrigine.html
"The revised labeling now includes a boxed warning which emphasizes that LAMICTAL® is not indicated for use in patients below the age of 16 years. Specifically, reports from clinical trials suggest that as many as 1 in 50 to 1 in 100 pediatric patients treated with LAMICTAL® develop a potentially life-threatening rash, as compared with a rate of approximately one in every thousand adults."
I used the following schedules:
---------------------------------
Without Depakote:
Weeks Dosage
1-2 25mg
3-4 50mg
5 100mg
6 150mg
7 200mg---------------------------------
With Depakote:
Weeks Dosage
1-2 12.5mg
3-4 25mg
5-6 50mg
7 75mg
8 100mg---------------------------------
- Scott
Posted by jzp on September 30, 2000, at 15:09:49
In reply to Re: Does Depakote cause depression? » Wilkie, posted by SLS on September 30, 2000, at 1:07:21
Two more cents from yet another Bipolar II patient. Depression is definitely my biggest issue, though hypomania has caused its share of problems in the past. For me, Depakote exacerbated an already-existing depressive episode.
My background with Depakote: I took just 500 mg/day for about 2 years (combined with Cytomel, thyroid supplement), and it was fine. No weight gain, no sluggishness, it just helped even me out a bit. It didn't flatten out the ups and downs completely, but I never got so depressed or hypomanic that I couldn't function. After going off this combination (partly because I was feeling better but mostly because of health insurance issues), I went into a pretty serious depression within a few months. I was hospitalized for a couple days, and they started me on 1500mg of Depakote and Wellbutrin. My new pdoc told me that there was no way that the 500mg I had taken before could have done anything, since the minimum effective dose is like 1000-1200mg. At any rate, after going on the higher dose of Depakote, I not only gained about 60 lbs in about 4 months, I also became more and more and more depressed. When I finally went off the Depakote (I was unemployed and had no insurance), I felt a little better, though still depressed, and stopped gaining weight, even if I didn't lose any.
Currently I am just taking Serzone, and it's made an incredible difference. No stabilizers right now, though Neurontin is waiting in the wings.
I stayed on Depakote much longer than I should have. It was clearly not helping. So don't do what I did-- talk to your doctor and try something else.
It helps so much to know that other people have gone through this same crap.
Posted by maggie on September 30, 2000, at 22:30:33
In reply to Re: Does Depakote cause depression?, posted by eh tu... on September 17, 1999, at 13:14:57
> > After all drugs known to humankind I was still
> > feeling in the dumps...
> > What gives, is it me or the depakote?
>
> Probably both. The drugs suck, life sucks and hence we become anonymous as the combo. jointly sucks and as we become more anoymous to ourselve and others we disappear or wish to erase ourselves...YES, I LIKE YOUR ANSWER...IT IS HOW I ALSO FEEL.
Posted by Ted on October 2, 2000, at 18:06:17
In reply to Re: Does Depakote cause depression?, posted by SLS on September 27, 2000, at 21:55:29
I have been on Depakote for 16 months now for Bipolar-II, rapid cycling, with chronic depression. I also take zoloft & wellbutrin to help with the depression, and I feel *lots* better than 2 years ago. I have read and studied depakote to the point I understand it better than my pdoc. For me, it seems to have worked well.
Here are some things you all should know (of course, YMMV):
1. The dose is unimportant. The valproate level in the blood is what matters. It should be 60-100 nmol/L. For me, at 195 lbs and 39 years old, 500 mg BID gives me a blood level of 65-70. Periodic blood tests are important for two reasons: It is hepatotoxic (destructive to the liver) and to measure the level in the blood. These tests should be done every 2 months for the first year, then 3-4 times a year afterward. (ref: Merck Manual, 1999)
2. There are some significant drug interactions with depakote that must be avoided. These include aspirin (acetaminophen & ibuprophen are OK) and the OTC stomache aids, like pepto-bismol, zantac, tagamet, etc. Also, NEVER break the tablets -- this guarantees gastric upset. (ref: PDR, 2000)
3. To combat hair loss, try adding selenium 200 micrograms and zinc 50 mg daily. Shampoo only with zinc- or selenium- based shampoos (head & shoulders, selsun blue, etc.). The efficacy is anectdotal, but seems to help.
4. To combat weight gain, EXERCISE. Walk, run, bicycle, etc. as much as you can. It also helps depression. I do things like walk 1.5 miles each way to return videos. Start slow, then build up. (ref: common sense & my pdoc).
Posted by Libby H on October 2, 2000, at 19:22:36
In reply to Re: Does Depakote cause depression?, posted by Carmen on September 18, 1999, at 20:09:25
I know I'm coming in a little late here, but this is an aspect of my treatment that I remember vividly, so...
I was taking Effexor XR 150 mg/day when I went on Depakote for mood swings. I called my pdoc (who is also my therapist) crying because I was overwhelmed by an interpersonal problem at work... The on call doc, having no idea that my doc had actually TOLD me to call in such situations, saw my crying about someone at work as evidence of Bipolar II Rapid-Cycling & managed to sell the diagnosis to my doc, who hadn't really known what to call my particular type of "agitation."
I took Depakote for about three weeks. In that short time, it reduced me to a crying couch potato with barely enough energy to sit up and less mental horsepower than my dog... I gained close to 20 pounds and felt more lethargic, less motivated, and more moody than ever before... I felt barely alive. My family finally insisted that I call my doctor & demand to be taken off Depakote because "it's killing you!" Now, I'm certain that Depakote has helped millions of people & I know several of them personally, but my experience with it proved to my satisfaction that I was NOT Bipolar!
So I did a little research and found I have Attention Deficit Disorder. The mood swings my doc saw were ADD-related. That is, they happened in response to situations that left me feeling overwhelmed. Like one day I locked my keys in my car & ended up sitting on the curb crying for a half hour. I wasn't cryng because of some big hairy emotional problem. I was crying because my brain didn't work & I couldn't make it work well enough to call a locksmith! I had a cell phone, mind you, but my synapses were firing so slowly that I couldn't sequence the events well enough to call a locksmith. Little problems, like having no pen to write numbers with & no memory to memorize them with, were more than I could stand to think about, so I sat down & cried until I finally thought to call a friend who could walk me through getting a pen & writing down the steps...
I read a lot about the differential diagnosis of ADD & BPII/Rapid-Cycling after my horrible experience with Depakote... I found misdiagnosis of bipolar disorder (esp. BPII/Rapid-Cycling) is fairly common in adults who have ADD... I read the symptoms of each disorder to several close friends & family members... All of them said ADD was much closer to the mark for me... So I took that information to my doctor and asked if I could try Ritalin rather than move to another mood stablizer. He said if I WAS Bipolar, it would be a bad move, but agreed anyway, saying
I'd know either way in a few days... He also referred me to a local ADD specialist for diagnosis... After several questionnaires, tests, etc. I was officially diagnosed with ADD. It was a little surprising to my doc because I am somewhat accomplished in spite of the "handicap" of ADD... Still, the tests (not to mention my moods & energy level) before & after Ritalin were amazing!For the past several months, I have been taking Ritalin (60mg/day) for ADD and Wellbutrin SR (300mg/day) for depression. I have never felt better! My motivation & drive are back and my brain even works... most of the time anyway.
:)So stick it out & trust your gut... If something
feels really wrong, it probably is... That's my experience anyway...L.
Posted by KarenK on October 10, 2000, at 15:20:57
In reply to Re: Does Depakote cause depression?, posted by Libby H on October 2, 2000, at 19:22:36
Before I started taking Depakote in June, I was very outgoing and chatty.. maybe a little hypomanic. Now I feel like it's a monumental effort to talk to anyone. It's sort of like I had personality plastic surgery and I got Streisand's nose without the voice. I've had the weight gain too as though I'm not heavy enough. My shrink suggested adding topomax to lose weight. Anybody know anything about that? I'm already on prozac which is supposed to reduce appetite and it's not. I feel like I'm a human chemistry experiment. This really sucks.
KarenK
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