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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.

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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. 

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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.

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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.

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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

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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 

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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.

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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

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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

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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.

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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.

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