Depakote - Side Effects/Dosage

[Guest PinkToo2grrl]

I've seen alot of talk about Depakote side effects, and very little mention of dosages involved.  I just started Depakote.  Looks like the pdoc thinks I am one of those people on the outer edges of the more recently explored "spectrum" of BP. 

anyway.  she is starting me on 500mg/day.  am I really going to "get fat, bald, tired, confused, uninterested in sex, unable to hold [my] liquor and everything will give [me] heartburn and/or the runs." ???

Look I know we are living in the world of what sucks less, and i just got a big slap in the face with how i used to feel pre-meds. So I am taking it.  I am rolling the dice.  The gamble is worth it.

But I also like to be an educated consumer, and I'd really like to know if at this dose, I really can look forward to that kind of hell.  I am halfway there already because of the depression, so wtf yanno, might as well go for it.  but ...

I am just curious how the side effects are tied to dose.  I know we're talking about blood levels for efficacy, but the pdoc didnt mention anything at all about checking for that.  only for checking liver function down the line if we stick with it.

So I am a tad confused (see half way there already)  any clarity from those in the know much appreciated.

[Sulu]

Pinky, I have been on Depakote(Epival) since last September, took 250 mgs for about a week and then to 500mg and have been taking that amount up until last night when I lowered it to 250 mg. (I am seeing pdoc Tuesday to discuss new meds) Hate to tell you this but yes, I have gotten fat, my hair has thinned and changed properties somehow), I am tired most of the time, my belly looks like a pregnant woman about to give birth, my skin sure ain't pretty, booze caused killer hang over, once was enough and I generally feel like shit.

[scatty]

When I was on 750 mgs depakote I lost massive amounts of hair and it turned out

my blood levels were very high (toxic.)  I highly advise blood monitering, esp. at

first.  What symptoms are you trying to control?  Depakote can be a harsh med but

it is very effective against mania for many people.  Good luck with it Pink!

[Guest PinkToo2grrl]

This is weird.  This must be working ok for someone if it is the #1 prescribed BP med.  (so says the oficial depakote website)

The pdoc rx'd it for dysphoric hypomania as described here.

seems i may well be on the BP spectrum.  just never diagnosed right because i have dysphoric manias. 

Fits of rage, quitting jobs, telling people to fuck off, basically getting really fuckin pissed off and flipping out. 

anyway.  since i started the cymbalta @ 2 weeks ago, my rage issues have been steadily worsening, and i finally called yesterday.  i was losing it yesterday.  Raging then crying.  calling the cops on the neighbors.  crying.  calling the DW's best friend a cunt.  crying.  bad day.  almost quit x2 w/in the past week.  freaked out on my boss, leaving nasty notes in the neighbor's mailbox.

yeah i guess this is the whole irritated dysphioric mania thing eh?  <sigh> if depakote is what i need to stop this so be it.  i wanna live a happy life.  i wanna stop leaving every job by blowing up, telling them off and walking out.  I wanna stop cursing out the people i love.  i wanna stop feeling suicidal because i am so ashamed of my behavior during these *episodes*

i'd rather not be bald, though , yanno.... ?  I don't know.  just feeling weird hearing BP, after almost 20 years of hearing something other than that yanno?  but the treatment resistant depression is a classic red flag for BP right?

ah I am babbling ...

I'm out.

When I was on 750 mgs depakote I lost massive amounts of hair and it turned out

my blood levels were very high (toxic.)  I highly advise blood monitering, esp. at

first.  What symptoms are you trying to control?  Depakote can be a harsh med but

it is very effective against mania for many people.  Good luck with it Pink!

<{POST_SNAPBACK}>

[Sulu]

Pinky, I was dx'ed as severe depression most of my life until, bipolar dx last fall.  It pissed me off at first and then I thought oh joy, maybe now they can fix me!  But then life never has been that easy for me.  As you said it is reportedly the most px'ed bipolar drug and like I said, you will probably hear more from the naysayers cause the yeasayers are out having fun and don't spend a lot of time here.  Let's hope it turns out to be the greatest thing ever invented for you, positive thoughts Pinky . Feel better soon, Sulu

[Guest PinkToo2grrl]

Thanks for the well wishes Sulu and Scatty .. I'm just freaking out totally here!!!  I hope its *the* drug too.  DW reassures me "Honey, you have a LOT of hair and a long way to go before getting to bald!"

Have you been having your blood monitored Sulu?

[Lisa_K]

Hey Pinky...Well...Im some sort of borderline and some sort of bipolar...(have docs that combat over which ones) and I am on 1000 mg of Depakote ER. I take it at night and have been doing so since March 2005.

Yes, its made sleepier, a little less motivated...I have noticed a change in hair and skin, but nothing like balding or anything crazy.I have very thick hair, so Im lucky, but it does shed alot. I havent gained weight, Ive actually lost weight, but Im also on 2 other anticonvulsants to control my epilepsy that have weight loss side effects. Plus depakote makes food...ummm... move through rather fast, to put it nicely.

The upside to Depakote for me? It has controlled the manic phases I was having that was making me hit rock bottom...I dont like being groggy, but to me its a fair trade off from feeling the rage, and severe despair that I cant explain in words that I was feeling all the time.

I can tell a big difference when I take my depakote, like theres some weight lifted off.

Like Sulu said though. all these meds affect people differently. I happen to like the effect depakote has on my moods, even though I could use some motivation at times...

[Sulu]

Have you been having your blood monitored Sulu?

Yes, about every 6 months now.  Always within acceptable therapeutic range.

[scatty]

I didn't mean to scare you Pink, just telling ya that blood testing is important.  You

can take zinc and another supplement (starts with an "s", can't recall) to offset any

hair loss.  I'm sure most people don't lose hair like I did as I'm med sensitive.  My

pdoc has many patients who are happy with it.  My mania is dysphoric too & I'm

trying to find the right meds.  I think depakote is pretty fast acting when you get to

a theraputic dose, so that's a good thing.  Like you, I got worse on an AD alone.

That's how I got dx'ed- totally flipped out on celexa!  I hope you feel better soon!

[Batou]

Pinky,

I took Depakote for a couple of years. At the time I did not have an "official BP Dx" but the pdoc was using it as a mood stabilzer. I eventually worked up to and remained at 2500mg a day. Spread out 500mg AM, 500mg PM, and 1000mg at bedtime. I did not gain weight but I was also on Adderall so it may have kept "some" weight off. I have very thin, fine hair but I never lost any hair, didn't even notice any gathering in my brush. I did have blood monitoring done pretty strictly. Once a month for the first few months, then every 3-4 months to check on therapeutic ranges.

The only negative effect was some word problems, somewhat like the Dopamax (Topamax) effect. I found myself writing words that were in no way related to sentence context. Some days I thought it was funny and always meant to record all the errors but I would always forget.

Good luck. Hope it helps you.

[Ben]

I'm on 1500 mg of Depakote and I haven't had any of those side effects.  I gained a little weight, but I was also on Risperdal and Lexapro, so who knows.  I needed the weight...I've lost it now that I'm on Abilify.

[NARS]

I've heard that most if not all Depakote side effects are dosage-dependant.

I took around 1000 a day for five years.  I did lose a little hair (thinning at the temples) but not much.  I did gain weight, but I have PCOS and so that's just the way it goes for me.  My skin is fine.  My digestive system calmed down after time.  I was less tired with time, too.  Had tremors at first, again better after several months.

And it did work.  I realize now (on another AC) that I still had some irritability and cycling on Depakote, but it was worlds better than ever before in my life. 

As for blood tests, every 6 months my pdoc ordered both depakote levels and liver function tests.  I think it was every 3 months at first.  I always came out at the bottom end of what he considered therapeutic, but since I was happy with how well I functioned he didn't make me take more.  My liver function levels were always fine.

You do need both tests, at least for the first year, if only to tell whether any cycling you're having is because depakote doesn't work or if you just aren't at a therapeutic level with it.

[Guest luli2545]

Hi Pink,

Just thought I'd add my 2 cents....started on I think about 750, "sprinkles" type depakote, reduced it to 500 mgs (Plain depakote) (not depakene) and did ok with it. It was an add on to seroquel, I think.

I do recall one day getting up from my bed suddenly and feeling a tad dizzy...that went away fairly quickly. No tummy problems at all. No change in menses. No extra hunger. Just felt better. So, now I do the 500 Depakote ER at bedtime.

Im  in third week of adding it back in (had gone off it to see what it was like, got depressed and anxious) I don't pay much attention to my dx cause it's been Gen. Anx. Disorder, PTSD after some harrowing stuff, Unipolar Depresssion, cyclothymia, whatever. It's about what works is my deal. I'll take it if I'm better on it balanced against side effects etc. And I'm better on it.

So anyhow, I'm no more lethargic than usual, less anxiety, no hair loss ever....but if folks are having hormone stuff due to aging or whatever they might lose some hair from menopause or whatnot, stress.

Blood levels are ok for me, just drop in to a lab...can't remember how often. I think it became once a year. I had some other lab work done sometimes (for hormone changes) and they'd test liver function and blood levels at those other places (primary care dr.) I didn't do a new blood level for going back on this time but I will after I check in with Pdoc in a week or so...liver function, blood level, maybe cholesterol...

For myself, regardless of its stated half-life etc, that it builds up in my system and just sort of stays there, gently supporting my relief from nutsiness. For myself, the times I've been off and gone back on it, it's a gradual feeling better kind of thing. (hey it worked for infants, it can work for me!)

I'm thinking for people who have lots of meds that the liver needs to process that it adds a load to that, so the tests are good for liver enzymes. Or if they have other liver problems it might not be great; they should really research it. And, as Jerod (I think) pointed out, taking milk thistle, which is supposed to help improve liver function, isn't good when on Depakote as I gather the Depakote doesn't get as much of a chance to help out, cause the milk thistle is speeding up or cleaning out the liver...(Primary Med. Dr. advised milk thistle to help with some chemo aftereffects, I was having lots of depr/anxiety about the chemo anyhow...just a heads up on liver detoxification)

So I  like my depakote ER.

Better living through chemistry!

Luli

[pressmama]

I have been on depakote for about 2 months and recently titrated up to 1250.  I have not (knock on wood) gained significant weight.  (Gone from 5'4" 125 to 128 lbs)  My skin is SLIGHTLY worse, no hair loss.  Massive stomach upset for 3-4 days after dose increase, but improves with use of Pepcid AC.  Probably the worst side effect is constipation.  None of them are bad enough to cause discontinuation.  But I'm not getting effective symptom control, so I'm going to talk to the doc about augmenting or switching. 

[The_Kenosha_Kid]

This is weird.  This must be working ok for someone if it is the #1 prescribed BP med.

Yep, and there's a reason you rarely hear from them.