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What is the role of divalproex sodium


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My diagnosis is schizophrenia I am on clozapine(for psychosis and intrusive thoughts) methylphenidate(for cognition and fighting anhedonia) and Brintellix.

 

My doc has also prescribed me divalproex sodium. Is it possible to figure out what is the specific thing he is trying to do by prescribing divalproex sodium and why I need it.

Edited by the maze runner
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Since one of its uses is the treatment of mania, I would agree that it likely has to do with mood stabilisation. Have you been feeling particularly elevated or highly anxious?

The best path is of course to ask your doctor - part of your relationship should involve his explaining to you why he is adding new meds to your current regimen. It's difficult for us to answer this other than in general guesses as to what his motivation might be.

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On 8/25/2021 at 8:38 AM, the maze runner said:

My diagnosis is schizophrenia I am on clozapine(for psychosis and intrusive thoughts) methylphenidate(for cognition and fighting anhedonia) and Brintellix.

 

My doc has also prescribed me divalproex sodium. Is it possible to figure out what is the specific thing he is trying to do by prescribing divalproex sodium and why I need it.

What @DogMan and @MiaB have indicated is true. The only way to get the real story is to ask your pdoc. Divalproex sodium, otherwise known as valproate or by the brand name Depakote, is an anti-convulsant with predominantly anti-manic properties, which is used in bipolar disorder. However, using it to augment an antipsychotic in schizophrenia is not only normal, it's actually quite common. Many people with treatment-resistant psychosis in schizophrenia who don't respond to or only partially respond to 5HT2A/D2 antagonist antipsychotics often do well with adjunctive valproate or lithium. Valproate and lithium typically don't have a ton of, if any, antipsychotic effect on their own, but coupled with a 5HT2A/D2 antagonist, they have strong potential.

Many times in schizophrenia, psychosis is believed to be mediated by dopamine hyperstimulation, hence the decades of D2 antagonists that throttle that activity. However in some cases, part of the issue is upstream with glutamate, which excites the brain, and GABA, which calms it. The brain normally converts glutamate into GABA and back to glutamate as needed to maintain brain excitability. Valproate induces the conversion of glutamate into GABA and inhibits the conversion of GABA back to glutamate, thus increasing GABA levels and thereby calming the brain. Reducing glutamate activity can also temper overexcitability of dopaminergic neurons in the pre-frontal cortex, which can reduce symptoms of psychosis. So by reducing brain excitability upstream with valproate, you reduce dopamine release, then clozapine takes care of the rest by blocking some of the post-synaptic dopamine receptors. This is generally how the AAP+valproate pairing is traditionally understood. 

Again, you'll have to talk to your pdoc about this, but it's also possible your pdoc has diagnosed you as schizoaffective, bipolar type, which might be another reason why an anti-manic agent like valproate was prescribed.

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