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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 cache-monkey on March 25, 2005, at 14:10:15
So, after a failed trial of Lithium (intolerable urinary side-effects), my pdoc's put me on Depakote. I'm well aware of the most reported troublesome side effects: hair loss, weight gain, libido decrease.
Im wondering, though: Has anyone out there has had success on Depakote (defined as achieving an acceptable level of stability) and _minimal_ side effects?
Also, is the ER version is any better than the standard (CR) version?
Thanks!
cache-monkey
Posted by Ritch on March 25, 2005, at 23:14:49
In reply to Depakote successes with low side f/x? (ER better?), posted by cache-monkey on March 25, 2005, at 14:10:15
> So, after a failed trial of Lithium (intolerable urinary side-effects), my pdoc's put me on Depakote. I'm well aware of the most reported troublesome side effects: hair loss, weight gain, libido decrease.
>
> Im wondering, though: Has anyone out there has had success on Depakote (defined as achieving an acceptable level of stability) and _minimal_ side effects?
>
> Also, is the ER version is any better than the standard (CR) version?
>
> Thanks!
> cache-monkeyActually, I've found that the weight gain I've experienced while on Depakote had as much to do or more to do with SSRI or Remeron usage than the Depakote itself. I'm just taking 250mg ER and .5mg of clonazepam and I weigh less now than I did when I was on 300mg of lithium with Prozac. That's the trouble with combos. You can't tell what's really causing what. I *do* definitely feel hungrier on higher doses of Depakote so it definitely can pack it on.. just be careful not to be on something else that also does that..
Posted by cache-monkey on March 26, 2005, at 12:48:43
In reply to Re: Depakote successes with low side f/x? (ER better?) » cache-monkey, posted by Ritch on March 25, 2005, at 23:14:49
Hi Ritch (Mitch?),
Thanks for the input. I don't know if I'm going to go all that high on Depakote. My pdoc was all about pushing the dose on Lithium past where I was actually feeling stable b/c I was not in the therapeutic range yet. That ended up leading to diabete insipidus. (Slowly clearing up now that the Li has been removed.) Hopefully he'll be more conservative and go off my subjective experience after that...
But still, the hunger thing could very well be an issue. Even when I'm unmedicated, I can get pretty revenous. (Although when I'm undmedicated, my guilt/anxiety/repressed emotions lead me to ignore it, be hungry and miserable.)
If I end up adding an AD, I'm pushing hard for low-dose selegiline. I think dopamine's my thing, since I've been self-medicating with cigarettes for years. (Plus caffeine, which also turns on the DA-juice.)
Out of curiousity, what's your diagnosis? BP of some form? Or was the lithium/depakote added as an adjunct to "boost" the prozac? Oh, and one more thing: any hair loss for you?
Thanks in advance,
cache-monkey<< Actually, I've found that the weight gain I've experienced while on Depakote had as much to do or more to do with SSRI or Remeron usage than the Depakote itself. I'm just taking 250mg ER and .5mg of clonazepam and I weigh less now than I did when I was on 300mg of lithium with Prozac. That's the trouble with combos. You can't tell what's really causing what. I *do* definitely feel hungrier on higher doses of Depakote so it definitely can pack it on.. just be careful not to be on something else that also does that.. >>
Posted by Ritch on March 26, 2005, at 17:19:12
In reply to Re: Depakote successes with low side f/x? (ER better?) » Ritch, posted by cache-monkey on March 26, 2005, at 12:48:43
> Thanks for the input. I don't know if I'm going to go all that high on Depakote. My pdoc was all about pushing the dose on Lithium past where I was actually feeling stable b/c I was not in the therapeutic range yet. That ended up leading to diabete insipidus. (Slowly clearing up now that the Li has been removed.) Hopefully he'll be more conservative and go off my subjective experience after that...
Depakote has a much "flatter" dose-response curve than lithium does (generally). Keep in mind, that the blood levels for Depakote were first established for control of epilepsy, and the blood levels that were established for bipolar were for bringing down an acute bipolar I type manic reaction. Maybe you could remind your pdoc of that distinction... You are just looking for a maintenance dose and treating BPII which generally requires much less.
>
> But still, the hunger thing could very well be an issue. Even when I'm unmedicated, I can get pretty revenous. (Although when I'm undmedicated, my guilt/anxiety/repressed emotions lead me to ignore it, be hungry and miserable.)I get the munchies on it when I'm up at 500mg a day. If you can avoid taking it in the daytime that *does* help. If you can take ER and hopefully you don't need more than 500mg.. and take it hs, you won't have the munchies as bad. The primary advantage of taking the ER version is it smooths out the peakiness of the first few hours after a dose so you don't get as easily nauseated (if that's a side effect you get). It also makes it possible to dose once a day.. there are migraine folks that take two 500mg ER at once (1000mg) just once a day.
>
> If I end up adding an AD, I'm pushing hard for low-dose selegiline. I think dopamine's my thing, since I've been self-medicating with cigarettes for years. (Plus caffeine, which also turns on the DA-juice.)Sounds like a good idea.. The best thing I've found (that I've tried) to offset (not intentionally) the Depakote hungries was Ritalin. I've never tried selegiline. The anti ADHD effect sounds appealing to me though.
>
> Out of curiousity, what's your diagnosis? BP of some form? Or was the lithium/depakote added as an adjunct to "boost" the prozac? Oh, and one more thing: any hair loss for you?
>
> Thanks in advance,
> cache-monkey
>I'm rapid-cycling BPII with seasonal depressions accompanied by lots of anxiety. I've also had two pdocs tell me they were convinced I had comorbid ADHD as well. Lithium was my first antimanic for many many years along with low-doses of conventional antipsychotics (Mellaril or Thorazine), and later a benzo (primarily Valium or Librium). Just in the last few years I went off the lithium and onto Depakote, and on clonazepam. I've never had any significant hair loss with Depakote at 250-375mg/day. When I was at 500mg/day regularly, I did get some hair loss, but not much. I take Folic acid/zinc/selenium to help that. The L-Carnitine I take also, which Depakote can deplete. You might (if you can tolerate it), see about a small dose of Topamax to take with Dep. to offset hunger and possibly help with anxiety. The Top can make you pretty stupid, but some people really don't get that. I slept great on it-that's one thing I definitely liked. Hope this helps-- Mitch
Posted by theo on March 27, 2005, at 16:30:11
In reply to Re: Depakote successes with low side f/x? (ER better?) » cache-monkey, posted by Ritch on March 25, 2005, at 23:14:49
This week I'm seeing my doc and I might start either 125mg regular Depakote or 250mg ER.
Does the 250mg ER help you with anxiety and low grade depression at all, mood lifting? What about side effects on 250mg. At such a low dose are the side effects mild?
Posted by Ritch on March 28, 2005, at 10:35:04
In reply to Re: Depakote successes with low side f/x? (ER better?) » Ritch, posted by theo on March 27, 2005, at 16:30:11
> This week I'm seeing my doc and I might start either 125mg regular Depakote or 250mg ER.
>
> Does the 250mg ER help you with anxiety and low grade depression at all, mood lifting? What about side effects on 250mg. At such a low dose are the side effects mild?Theo, I would try the 125mg to start if you are the least med-sensitive and your manic-like symptoms are mild. Whenever I started Depakote back up about three years ago, that's what I did and I got some cognitive sfx even at that low a dose-but they faded after a couple of weeks, and then I went up to 250mg. I go to 375mg or 500mg just temporarily (a day or two), when I get a little too high every 2-3 weeks, otherwise it will make me VERY tired. Depakote doesn't do much for my depressions-it *will* reduce agitation associated with a depression, but you aren't likely to get a motivating "boost" or anything like that. You'll need an AD with it or another mood stabilizer (lithium,i.e.) if you have chronic dysthymic stuff. I think it does clearly help with anxious agitation, anger, and cycling-it is only really effective for manic related symptoms. At 250mgER the only side effects that I find annoying are transient daytime sleepiness. In my case I think it is somewhat sleep *disruptive*. I have this delayed sleep thing where I want to keep sleeping later every day and going to sleep later all the time. It is like the Depakote is *increasing* the duration of my day somehow. But, that's just my troubles with it-you might not have these problems.
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