Jump to content
CrazyBoards.org

Recommended Posts

Hi, 

Recently my care team has noticed some changes in myself and the current consensus is that I may have went from depressive type to bipolar type of schizoaffective disorder. These changes progressed over the course of a year (but I have been flat out diagnosed for over 4 years, the type of illness has changed over time). I went from schizophrenic to schizoaffective depressive, and now it's possible I became bipolar type (as everyone has seen me pretty much every day, minus him, and noticed these changes that I noticed as well). 

The thing is that I am already on a unique regimen which the medications in theory should be helping my manic/hypomanic states (though I ended up on them as a depressive type). I take abilify maintena once every 4 weeks and invega trinza every 12 weeks (injections). My doctor discontinued my SNRI (effexor). He is letting me decide what I feel is better to do in this situation given that I am on a unique regimen and yet my hypomanic/occasional full blown mania states are coming up regardless. Of course, he still has a final say. He gave me some guidelines to look at to get an idea and discuss what I'd like to do at my next appointment. Since I was on carbamazepine (tegretol) in the past when my dx was very "not otherwise specified" I naturally jumped to that. He rejected the idea on the basis that it would react with some of my medications and we want my psychosis to remain mostly in control.

Upon looking into it, I was looking at the different lines of treatment and Depakote came up. I was wondering how effective this drug is in combating mania/hypomania associated with schizoaffective bipolar, or even bipolar in general. Everyone is different so I'm looking for the good, the bad, and the ugly.

Thanks.

Share this post


Link to post
Share on other sites

I was given depakote during a manic episode in a psych hospital and it did a really great job...too good....all I remember was sleeping for a week straight, which felt good at the time. I don't remember why I was taken off of it. Maybe the sedation was impossible to deal with outside a hospital setting. As I understand, it works just for mania and not depression. Have you also considered lithium. You definitely should be on a mood stabilizer along with an antipyschotic. 

Share this post


Link to post
Share on other sites

I have schizoaffective bipolar type. I was on depekote for many years to good effect for most of them. I was told it is very effective for mixed states. It started to make me really flat, though, to the point I finally asked for a change. It never really stopped working as a mood stabiliser though.

Share this post


Link to post
Share on other sites

I am bipolar and been off meds for awhile because of side effects. I was really manic and went to see the ER Psych facility. The pdoc had me take Depakote. He told me to increase my dose until I felt goog. That was at 900mg.

i stopped taking it when I was stable because I couldn't take he sedation. Also I think I had dry mouth. The worst  side effects were: nausea and diarrhea. I was always running to the bathroom.

 

about 5 years later I was in the same type of mania. I had moved and started to see a new pdoc. He put me on Seroquel and Lamictal and the crazies went away.  Finally side effects that were tolerable!  I have now accepted I needed the meds and have been medicated religiously for the last 15 years.

Share this post


Link to post
Share on other sites
On 02/02/2018 at 4:16 PM, CeremonyNewOrder said:

I was given depakote during a manic episode in a psych hospital and it did a really great job...too good....all I remember was sleeping for a week straight, which felt good at the time. I don't remember why I was taken off of it. Maybe the sedation was impossible to deal with outside a hospital setting. As I understand, it works just for mania and not depression. Have you also considered lithium. You definitely should be on a mood stabilizer along with an antipyschotic. 

Yeah. The reason why my psych does not want me on lithium is the potential to damage kidneys and thyroid. So we are thinking about depakote

Share this post


Link to post
Share on other sites

The kidney thing usually takes many years...I've been on it over 5 at high dose and no kidney issues...it happened to a family member but they were on it like 20 years first 

Share this post


Link to post
Share on other sites
5 hours ago, Iceberg said:

The kidney thing usually takes many years...I've been on it over 5 at high dose and no kidney issues...it happened to a family member but they were on it like 20 years first 

Yes and while your on it, your pdoc will give you routine tests to check your kidney function.

Share this post


Link to post
Share on other sites
On 2/2/2018 at 3:51 PM, xanathos said:

Hi, 

Recently my care team has noticed some changes in myself and the current consensus is that I may have went from depressive type to bipolar type of schizoaffective disorder. These changes progressed over the course of a year (but I have been flat out diagnosed for over 4 years, the type of illness has changed over time). I went from schizophrenic to schizoaffective depressive, and now it's possible I became bipolar type (as everyone has seen me pretty much every day, minus him, and noticed these changes that I noticed as well). 

The thing is that I am already on a unique regimen which the medications in theory should be helping my manic/hypomanic states (though I ended up on them as a depressive type). I take abilify maintena once every 4 weeks and invega trinza every 12 weeks (injections). My doctor discontinued my SNRI (effexor). He is letting me decide what I feel is better to do in this situation given that I am on a unique regimen and yet my hypomanic/occasional full blown mania states are coming up regardless. Of course, he still has a final say. He gave me some guidelines to look at to get an idea and discuss what I'd like to do at my next appointment. Since I was on carbamazepine (tegretol) in the past when my dx was very "not otherwise specified" I naturally jumped to that. He rejected the idea on the basis that it would react with some of my medications and we want my psychosis to remain mostly in control.

Upon looking into it, I was looking at the different lines of treatment and Depakote came up. I was wondering how effective this drug is in combating mania/hypomania associated with schizoaffective bipolar, or even bipolar in general. Everyone is different so I'm looking for the good, the bad, and the ugly.

Thanks.

Your doctor's concerns about carbamazepine are understandable, well-founded, and a sign that he is a smart doctor. Carbamazepine induces a lot of liver enzymes which would reduce the levels of your aripiprazole and paliperidone injections. Carbamazepine's cousin, oxcarbazepine (Trileptal), has similar efficacy to carbamazepine without nearly as much effect on liver enzymes as well as fewer side effects in general. Many people who respond well to carbamazepine but have tolerability issues find that switching to oxcarbazepine usually resolves their issues. Unfortunately, generic oxcarbazepine is immediate release and has to be taken at least twice a day but I ultimately had to take 300mg three times a day. It has such a short half-life that if I only took it twice a day I would start to feel anxious and jittery in the afternoon before my next dose. I eventually switched to the extended release brand name, Oxtellar XR, which actually really improved symptom control. Unfortunately, oxcarbazepine really just wasn't quite enough for my mania, which is when we switched to Depakote. Honestly, going on Depakote was the single best medication decision that my doctor and I ever made. And in this particular situation, I actually asked my doctor to be put on it despite my concerns about weight gain and liver toxicity, and things have really be great. Also, I only take 1000mg which results in a 43mcg/ml blood level. The usual range for Depakote is 50-100mcg/ml, but when I tried to increase from 1000mg to 1500mg, I actually started getting depressed so I dropped back down. Haven't tried 1250mg though.

On 2/2/2018 at 4:16 PM, CeremonyNewOrder said:

I was given depakote during a manic episode in a psych hospital and it did a really great job...too good....all I remember was sleeping for a week straight, which felt good at the time. I don't remember why I was taken off of it. Maybe the sedation was impossible to deal with outside a hospital setting. As I understand, it works just for mania and not depression. Have you also considered lithium. You definitely should be on a mood stabilizer along with an antipyschotic. 

I titrated up on Depakote pretty rapidly. Started at 250mg and got up to 750mg in less than 2 weeks, but I have to say that any mania I was feeling as part of my titration from Oxtellar to Depakote was aborted within like 2-3 days. It's pretty fast despite the fact that they say Depakote takes a good 2 weeks to achieve stabilization.

On 2/3/2018 at 4:31 PM, xanathos said:

Yeah. The reason why my psych does not want me on lithium is the potential to damage kidneys and thyroid. So we are thinking about depakote

Yeah well Depakote is rough on your liver so you win some you lose some. :P

Share this post


Link to post
Share on other sites
5 hours ago, browri said:

Your doctor's concerns about carbamazepine are understandable, well-founded, and a sign that he is a smart doctor. Carbamazepine induces a lot of liver enzymes which would reduce the levels of your aripiprazole and paliperidone injections. Carbamazepine's cousin, oxcarbazepine (Trileptal), has similar efficacy to carbamazepine without nearly as much effect on liver enzymes as well as fewer side effects in general. Many people who respond well to carbamazepine but have tolerability issues find that switching to oxcarbazepine usually resolves their issues. Unfortunately, generic oxcarbazepine is immediate release and has to be taken at least twice a day but I ultimately had to take 300mg three times a day. It has such a short half-life that if I only took it twice a day I would start to feel anxious and jittery in the afternoon before my next dose. I eventually switched to the extended release brand name, Oxtellar XR, which actually really improved symptom control. Unfortunately, oxcarbazepine really just wasn't quite enough for my mania, which is when we switched to Depakote. Honestly, going on Depakote was the single best medication decision that my doctor and I ever made. And in this particular situation, I actually asked my doctor to be put on it despite my concerns about weight gain and liver toxicity, and things have really be great. Also, I only take 1000mg which results in a 43mcg/ml blood level. The usual range for Depakote is 50-100mcg/ml, but when I tried to increase from 1000mg to 1500mg, I actually started getting depressed so I dropped back down. Haven't tried 1250mg though.

I titrated up on Depakote pretty rapidly. Started at 250mg and got up to 750mg in less than 2 weeks, but I have to say that any mania I was feeling as part of my titration from Oxtellar to Depakote was aborted within like 2-3 days. It's pretty fast despite the fact that they say Depakote takes a good 2 weeks to achieve stabilization.

Yeah well Depakote is rough on your liver so you win some you lose some. :P

Yeah I looked into that. Concerns me a little because my mother has a fatty liver and it seems to run in my family. It sucks i have a long wait to see him to give my suggestion and my moods are getting very erratic. Before I was mostly depressed then had hypomania/stuff once in a while but the times in between are getting shorter and im experiencing mixed states which makes me and my loved ones nervous because I have enough energy to plan out my passing ugh all aboard the sza bp express! Hope i dont crash and burn x.x

Share this post


Link to post
Share on other sites
12 hours ago, xanathos said:

Yeah I looked into that. Concerns me a little because my mother has a fatty liver and it seems to run in my family. It sucks i have a long wait to see him to give my suggestion and my moods are getting very erratic. Before I was mostly depressed then had hypomania/stuff once in a while but the times in between are getting shorter and im experiencing mixed states which makes me and my loved ones nervous because I have enough energy to plan out my passing ugh all aboard the sza bp express! Hope i dont crash and burn x.x

Mixed states are a real problem for me too. Depakote has done well with those. No complaints here.

Share this post


Link to post
Share on other sites

I've been on lithium for 8-10 years (I think 10), and I had kidney disease when I started it. My kidneys haven't gotten worse at all. We check my kidney levels about 3 or 4 times a year, and I do lithium levels 2 or 3 times a year. I had a really bad kidney infection a few years ago, and the doctor said if I had delayed seeking help for another day or two, I might of lost my kidney. And he *STILL* didn't think I should come off the lithium, and said it had nothing to do with it.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now


  • Similar Content

    • By mikl_pls
      Towards the end of August of this year and the beginning of this month, I was a bit manic, and then on 9/5/18, I saw my pdoc, and she put me on divalproex sodium ER (Depakote ER) 500 mg every morning and olanzapine (Zyprexa) 10 mg as needed for mania.
      Since starting the Depakote, I've already noticed that I am feeling rather flat and unmotivated, and that I'm slowly becoming depressed. It's been about four days into taking the Depakote, not long really, but I'm a little alarmed. A good friend of mine who's very knowledgeable with medications said that this is a very small dose, and I deduced that I would not feel much of anything, but I'm wondering if I'm sensitive to the anti-manic effects of it and that it might be putting me "too far on the other side" of euthymia...
      Does anyone maybe have any insight on this, or has anyone maybe even experienced this same thing? Could this possibly be the Depakote this quickly into taking it, or is this maybe just "post-manic depression," or what? 
      I've also been taking the olanzapine (Zyprexa) nightly since it was prescribed to me to make sure I get good sleep, as getting good sleep was one of the things my pdoc instructed me to do since the main thing that precipitated my manic episode was lack of sleep. This probably confounds the clinical picture a bit, but I figured I would mention this.
      Any input would be much appreciated. Thanks!
    • By Igobihim
      Hello, 
      I do like to talk, but I will keep it simple. I get manic at times, I manage it by writing. 
    • By Catmomma12
      I have been a long time user of depakote, over 15 years and while it has done a fantastic job of helping to stabilize my moods, with the addition of geodon, I am unhappy with the major hair loss it has caused.  My pdoc has recommended either lithium or vraylar as a substitute.  Has anyone switched to either of these two meds from depakote?  What are your experiences?  Side effects?  I am anxious to stop the hair loss but am afraid to give up the stability I have.  Another concern is weight gain.  I have recently lost 75 pounds of seroquel weight and am in no hurry to gain it back.
      I have bipolar disorder with psychotic episodes that is currently well controlled.  Any suggestions?
    • By browri
      Does anyone have any experience specifically with the Depakote+Lamictal combo (with or without other medications). I've been on Depakote now since about November of last year but we're swapping out the Trintellix for Lamictal because my new insurance in July might give me a hard time about covering Trintellix. And we (my pdoc and I) figured that demonstrating an approved medication doesn't work (if it doesn't work that is) should be something we should try before submitting the step therapy paperwork for Trintellix. For this new insurance, they not only require that you try at least two other generics, but the "Restricted Access" meds also are only allowed to be used for FDA approved indications (i.e. Trintellix is approved for MDD but I'm BP2).
      I started Lamictal on Thursday. 25mg every other day for 2 weeks. Then 25mg every day for two weeks. Then we'll decide if we want to increase it again to 50mg for another two weeks or if we want to increase the Depakote or Rexulti.
      I don't recall Lamictal having such a difficult startup when it comes to GI discomfort. I remember the antsy almost anxious feeling, and I remember the headaches, but I'm also having nausea, some mild stomach cramping, diarrhea, but fortunately no vomitting. Has anyone else ever taken Depakote and started Lamictal and found they had a hard time. Better yet has anyone ever taken Lamictal both with AND without Depakote and found it less tolerable when taken with Depakote?
      I am aware of the medication interaction between these two meds. So I know that Depakote is going to increase Lamictal blood levels and might amplify some of these side effects. It's just more difficult than I remembered from the last time I took it years ago when I wasn't on Depakote and I wasn't really expecting it to be this much worse. Granted, I've only taken two doses at this point. So I might be jumping the gun and might find that I feel better later this week. But I'm also supposed to be discontinuing the Trintellix on Thursday. And if I'm still having a hard time adjusting to the Lamictal, stopping Trintellix at the same time could make me miserable, and I know that.
      Anyone have two cents? 
    • By Cyclingsarah
      Hey guys.
      I’ve been pretty stable on Depakote, but it sure does come with some undesirable side effects. Somehow it makes me feel overwhelmed. It’s kind of a brain fog 2.0 feeling. Also it haven’t helped much with my anxiety, and there’s still some depression left too. 
      I’m also on 2 antidepressants and a small dose of gabapentin, with no luck.
      What are your experiences with lithium or seroquel? I do not want to feel like a zombie and also do not want to feel too flat or foggy
×