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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!

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20 minutes ago, mikl_pls said:

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!

Yes. The same thing happened to me on it around 20 years ago. Hated that one. 

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Zyprexa makes me more depressed but does help with sleep. 

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3 hours ago, gb84 said:

Zyprexa makes me more depressed but does help with sleep. 

Yes, I too find that Zyprexa makes me a bit more depressed. Yet this time around (I started taking it before my appointment with my pdoc, about 2 or 3 days before), I'm finding that it is brightening my mood just a tad. But I guess maybe that effect might have worn off or has reverted back to making me feel depressed again. Who knows... maybe I should stop taking it. I've been reading lots of good things about trimipramine (Surmontil) as far as helping with sleep and depression. I'm thinking about making a post about it, but it's pretty obscure. I doubt if anyone on here has taken it.

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Depakote made my depression worse. I also ate everything that wasn't nailed down. I think I was on 1000 mg, but I don't really remember for sure. YMMV.

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I hated Depakote. Sucked the life right out of me.

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For an anti-manic, Depakote is the only thing that's provided me complete relief. Everyone knows that lamotrigine is a mood stabilizer but it wasn't exactly "calming" and I tried oxcarbazepine which worked fairly well but I just needed something more calming. Depakote really was it for me. Hasn't had an appreciable effect on my weight or appetite, but I have gained some, and I'm also on Rexulti which doesn't help matters.

500mg of ER really is a small dose in the grand scheme of things, but 500mg of Depakote ER with Zyprexa is a bit different I suppose as they are both potent anti-manics. My recommendation really would be to move the Depakote to the evening if your pdoc doesn't have a problem with it. Might further assist with sleep and help to keep the VPA levels lower during the day.

For me, the depressive feelings came at about 1500mg. It's possible that you might just be sensitive to it. I think we determined that you have high MAO-A and COMT correct? Depakote will further increase MAO-A and inhibit synthesis of catecholamines (exacerbating the COMT problem). So you could be looking at some monoamine/catecholamine "depletion" (if you want to call it that). But post-manic depression seems more likely.

I guess I just don't see any reason to use moderate dose olanzapine with small dose valproate. 10-15mg of Zyprexa should be able to squash most things. I personally never took more than 5mg of it.

 

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It is kind of a quandary what’s doing what when you’re on two mania-stompers at once. 

Have you checked your blood pressure? In 2016 I went sufficiently nuts that my pnurse put me on Zyprexa to try to shut down the mania. It didn’t work, but it tanked my BP -dropped it into 80/40 range- and made me feel speshul weird

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When I started depakote, the dr told me it can level you out, but leave you depressed. She said I might need to add something else in to combat depression. I had a bad reaction and didn't keep taking it, so I never got that far.

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