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Hello everyone! So, this is more exploratory than anything. I accept that, as someone with bipolar disorder, taking an antipsychotic might be a necessary part of my maintenance treatment, and lately that has become more evident. I had been taking Rexulti (brexpiprazole) in varying doses since 2017 when I started it with Depakote ER (divalproex, 24-hour) and Trintellix (vortioxetine). Still taking the Depakote (now up to 1500mg), but Trintellix and Rexulti have worked their way out of the equation, as of late. My medication regimen has taken a more classical turn due to a breakthrough hypomanic episode in Dec./Jan., and I am currently taking a combo of Depakote ER at night along with 0.5mg of Risperdal (risperidone). Because of persistent issues with depression and anxiety, I am also now taking 50mg of Pristiq (desvenlafaxine) each morning along with 50mg of Vyvanse (lisdexamfetamine) for ADHD that I have been taking for some time. This combo seems to be working fairly well for me. When I started the Risperdal at 0.25mg/day at bedtime, I didn't really notice much difference at all during the day, but I suppose it was nice as a sleep aid. I increased to 0.5mg on Day 4 and I've parked here to try it out for a bit before deciding to increase further. The Risperdal is really to deal with those breakthrough hypomanic/mixed symptoms such as irritability and agitation, which have always been tough for me. In the beginning of my treatment (2014), antipsychotics were used as monotherapy for mood stabilization, but I could never tolerate the doses necessary to calm those symptoms, because I was easily susceptible to EPS like akathisia. Fast-forward a few years, and we've found that using an anticonvulsant as the primary mood stabilizer with the antipsychotic as a secondary has generally served me well without too much incidence of akathisia. I started Risperdal on June 8th and increased to 0.5mg a few days afterward. So it's been almost 3 weeks at this dose. My experience so far tells me to keep increasing. I'm curious to know people's experiences on Risperdal, particularly in combination with another established mood stabilizing agent like lithium or valproate. I recognize that I take Depakote and that a combo of lithium+Risperdal may not be the same, but the mood stabilizing effects of lithium and valproate are generally regarded with equal respect in most literature for the time being. Any thoughts on lower dose Risperdal?....particularly in concert with another mood stabilizer?

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?

Currently on a low dose of 500 mg of Depakote ER (blood level ~43), along with Lamictal and a couple other meds (see sig.) I want to ditch Depakote because the combination of two mood stabilizers is messing with my cognitive function. I have Bipolar type II: infrequent episodes of irritable hypomania, predominantly depressive episodes (previously rapid cycling). I *think* my pdoc and I added Depakote to help with irritability and/or agitation, but naturally I can't remember. I have since stopped cycling now that I'm taking two AED mood stabilizers. But I'm not fully convinced I need both to maintain wellness; I don't think I was on Lamictal long enough to gauge whether or not it could act as monotherapy. I've been reading plenty of articles where Lamictal is effective as a standalone mood stabilizer. I suppose what I'm looking for is insight/input as to whether or not people are able to manage BP2 without Depakote, or perhaps for those that currently take Depakote, why do you take it?

So l saw my pdoc today and he has decided to discontinue my lithium totally. This is due to the latest blood tests which shows I have grade 3 (out of 5) chronic kidney disease. He started me on Epilim Chrono (sodium valproate) which most people know as depakote. My starting dose is 400mg. I was on this several years ago with a lot of other medications so cannot recall side effects. I know that weight gain can be a problem. My pdoc also said that I may feel sedated on it. Any side effects I should be aware of?? Also, going off lithium is of great concern. I was on it for 13.5 years. I have been tapering off it and I know there is a real risk of me becoming manic. My pdoc will be seeing me more frequently to keep a good check on things and the community psychiatric nurse will be in close contact with me. For anyone who has had to taper off lithium...... Was it a rocky road?? For anyone switching from lithium to valproate..... How did it go? Boy do I HATE change!!!!!

Hi all - good to be here, this is my first post! I was diagnosed with MDD 5 years ago, when I was 20. I tried various antidepressants - they sent me up like a helium balloon. To cut a long story short, I was diagnosed with BP 6 months ago. I had a really rough time at university, dropped out, spent thousands of pounds I didn't have, and it feels like years later, I'm still picking up the pieces. Over the last several months, I've tried Quetiapine (Seroquel) and Lamotrigine (Lamictal). Quetiapine made me feel like a drooling zombie and sleep for 14 hours at a time, and with Lamotrigine, I developed some hypersensitivity symptoms like swollen lymph nodes etc, so my Doc decided it was best to stop. He's since suggested and prescribed Sodium Valproate (not sure what preparation yet, I'm guessing it'll be Depakote). I've lost a substantial amount of weight over the last few years, which I'm very happy about - after reading other people's experiences, I'm pretty terrified that the SV is going to make me gain a lot back. The last week or so, I've convinced myself that I don't need any medication - that I'm e than I think I am right now, and I will cope. Now obviously I start to wonder, am I just really hypomanic? The sense of not being able to trust my own emotions is unsettling. I definitely suffer with depression more than hypomania, but I'm also beginning to wonder if I experience mixed states. After writing this post I think I'm more confused than when I started. Any kind of input, experience with SV, general info, would be much appreciated. TVM x

I have been on a full dose (1000mg) of Depakote for about a week now after switching off of Trileptal which worked well for me for about two and a half years (but then stopped working and started in on making me physically ill constantly). I've seen a severe worsening in my depression (which was already bad enough, alternating with mixed episodes, that I was on temporary disability due to being unable to work). Could this just be that the Depakote hasn't really kicked in yet, and I'm happening to have a bad depressive episode? If it's the Depakote worsening the effects, is there any chance that if I keep at it eventually it will make the depression better instead of worse? I am Bipolar I, currently taking Depakote, Abilify, Xanax on occasion. I've been on the Abilify a long time, and take the Xanax currently almost every day, but on average when stable about once a month. -L