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What's your daily Depakote,Depakote ER dosage and level? Currently mine is only 1000mg, i was on 1500mg 4 months,but lately it caused depression so dose was reduced to 1000mg. Is it enought for bipolar maintenance? Does levels correlate with clinical efficiency? 

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Usually a serum level is drawn to check your levels. The reference range is determined by the lab, so it can vary slightly from place to place. It usually takes about a week for your levels to stabilize when you switch dosages due to the half-life. I know that when I was on 1500mg of ER, my level was above therapeutic, so we cut it back to 1000mg to keep it in range.

Ultimately, Depakote didn't work for a lot of reasons, but your serum level should be checked to see where it falls in the range, and if it's clinically therapeutic or not as a starting point.

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From drugs.com:

Quote

Mania

Depakote ER tablets are administered orally. The recommended initial dose is 25 mg/kg/day given once daily. The dose should be increased as rapidly as possible to achieve the lowest therapeutic dose which produces the desired clinical effect or the desired range of plasma concentrations. In a placebo-controlled clinical trial of acute mania or mixed type, patients were dosed to a clinical response with a trough plasma concentration between 85 and 125 mcg/mL. The maximum recommended dosage is 60 mg/kg/day.

 

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I titrated up to 750mg over the course of 5 days and my pdoc had me wait 5 days from there before getting levels. 750mg came back as a 38, so we upped it to 1000mg. I've had two levels done at 1000mg which come back ~43. We shoved on to 1500mg even though my symptoms were relatively under control to see if it put me into the 50-100 range but I started to get depressed pretty quickly after that and we reduced it back down to 1000mg. Wasn't on 1500mg long enough to get a level.

My pdoc's opinion is that 1000mg is an "average dose" as he put it. He told me that if symptoms were well-controlled there wasn't any reason to force it. When he elaborated a bit further, he said that "clinically acceptable levels" of anticonvulsants were established when their main purpose was to treat epilepsy and that while higher levels may be needed for seizure control, higher levels may not be needed for mood control. Meaning someone with grand mal epilepsy may require a 100 blood level to remain seizure-free but someone with bipolar 2 disorder that has a lower grade hypomania may show an acceptable or even significant amount of improvement even <50. A good example of this would be lamotrigine. Sufficient seizure control can require doses of lamotrigine up to 600mg, but statistically speaking, in trials, not much more improvement was seen in bipolar disorder beyond 200mg. That being said there are still people that have 300-400mg of lamotrigine as the backbone of their cocktail. YMMV always.

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