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Re: Does Depakote cause depression? » Wilkie

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:

"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




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