Tapering off of Depakote and onto Trileptal

[dolcebellaluna]

I saw my p-doc a week ago and confronted him about the weight I've gained over the past year, after stopping Lithium and then trying Seroquel, Zyprexa, and finally Depakote. I've gained about 50 pounds without any change in eating habits or exercise and I decided that I'd had enough of it! I talked to my p-doc and he told me we could lower my dose of 1500 mg Depakote daily to 1000 mg daily for 6 weeks. I wanted to be started up on another mood stabilizer in the meantime, but he didn't like the idea and said we could re-consider it at our next appointment. No less than two days after I started taking the lower dose, I felt like all of my soft signs of depression were lurking at every corner.

• Increased sleep
• Decreased appetite and sex drive
• Low motivation and poor concentration
• Poor self image
• Increased tearfulness and irritability

After 5 days of this, I attributed these feelings to my bi-polar illness relapsing after not being masked anymore by the Depakote. I saw my p-doc again today and begged him to put me on something in the meantime. He was curt and impersonable with me and printed out the prescription without even talking to me. I had to run back in the office and ask him when he wanted to see me again to see if the Trileptal is working. He put me on 300 mg of Trileptal twice a day and said he'll see me in 3 weeks. He didn't tell me to stop my Depakote taper, but I wish I could. I don't see how being on two anti-convulsants makes much sense.

Has anyone else ever tapered off of Depakote and onto something else simultaneously? Does this picture sound right?

Edited August 11, 2010 by dolcebellaluna

[domovoi]

i was taking depakote for about 5 years, 1000-1200. when the pdocs finally realized it was not working they did a pretty intense in my view thing, which was switching me to lithium in.. let's see: first two weeks, depakote ↓ to 600 start lithium at 300, next two weeks depakote ↓ 300 lithium ↑ 600 then last 2 weeks d/c depakote, lithium ↑ 900... for the next two months lithium ↑ 1200 which is how much i take now.

it was difficult. i was having very intense mood swings, sometimes a couple of times a day. i remember getting on a bus ecstatically on an impulse to get a tattoo then missing my stop and riding around the route 2 times while crying. for some time i had insomnia and a lot of anxiety. generally, i did get depressed but i guess i have to keep in mind that a lot of these things are due to my propensity for mixed states, and also because i switched to LITHIUM which is a thing in and of itself. so, i think for a while my illness was exacerbated by the switch.

your pdoc does not sound terribly supportive.. getting off or switching to a new AC is a very serious matter. however, 3 weeks i think is not such a long time as long as he is very attentive to your symptoms... good luck!

Edit: by three weeks i mean seeing your pdoc every 3 weeks which i think is reasonable. but i also wanted to add it took me about 2-3 months after being fully on lithium to stop feeling like crap (moodwise, not side effects, that's another story)

Edited August 15, 2010 by domovoi

[dolcebellaluna]

i was taking depakote for about 5 years, 1000-1200. when the pdocs finally realized it was not working they did a pretty intense in my view thing, which was switching me to lithium in.. let's see: first two weeks, depakote ↓ to 600 start lithium at 300, next two weeks depakote ↓ 300 lithium ↑ 600 then last 2 weeks d/c depakote, lithium ↑ 900... for the next two months lithium ↑ 1200 which is how much i take now.

it was difficult. i was having very intense mood swings, sometimes a couple of times a day. i remember getting on a bus ecstatically on an impulse to get a tattoo then missing my stop and riding around the route 2 times while crying. for some time i had insomnia and a lot of anxiety. generally, i did get depressed but i guess i have to keep in mind that a lot of these things are due to my propensity for mixed states, and also because i switched to LITHIUM which is a thing in and of itself. so, i think for a while my illness was exacerbated by the switch.

your pdoc does not sound terribly supportive.. getting off or switching to a new AC is a very serious matter. however, 3 weeks i think is not such a long time as long as he is very attentive to your symptoms... good luck!

Edit: by three weeks i mean seeing your pdoc every 3 weeks which i think is reasonable. but i also wanted to add it took me about 2-3 months after being fully on lithium to stop feeling like crap (moodwise, not side effects, that's another story)

Thank you for your support and feedback. Seeing him every 3 weeks is a miracle for me...it's usually every 6, if not longer. I just think that taking 12 weeks (6 at 1000 mg and 6 at 500 mg) feels like forever on a drug that I don't want to be on anymore. Thankfully, I haven't really been feeling side effects and the Trileptal is definitely having some effect on me. So far, no rapid cycling, but increased sensitivity and decreased self esteem and appetite. I'm happy with the decreased appetite, honestly.

[bpladybug]

It is very difficult to taper off of a mood stabilizer such as Depakote, and slowly add something new. Some years ago I tapered off of Depakote and it was a nightmare. One of the hardest things I have experienced. I think it needs to be slow so the brain chemistry can adjust. As I read your sig it says you are tapering off Klonopin? Is that right? Are you tapering off Depakote and a benzo at the same time?? jeez That is too much.

[crtclms]

I just tapered off of Depakote, I had been on amounts between 1000 and 1500 mg for the last 5 years. Ostensibly, I was on it for migraine prophylaxis, and *not* for mood stabilization. But as I lowered my dosage, I definitely whacked out, and we had to play with my Lamictal and Xanax.

By the way, it isn't totally awful to be on to AEDs at once: I was on two at once for two years, and my husband is on three of them.

[PetSoundsFan]

I was put on Depakote and got up to 1000 mg. The weight gain and constipation was incredible. Last month the pdoc had me taper down to 500 mg as we were going to switch to something else. Up until Monday, I was on 500 mg for the last two weeks and I really noticed a difference...cycling, started to feel very anxious and manicy as well as some beginning signs of depression.

On Monday I cut the depakote out and began 150 mg of Trileptal in the morning and 300 mg in the evening. On Saturday I'll go to 300 mg in the morning and 600 mg in the evening. Last night I lied down to go to sleep, closed my eyes and saw, as clearly and perfectly as if it were real, me driving a big truck from my point of view..that is, I didn't see it in third person. My body shook as if I were driving a big Uhaul...I don't think I physically shook but I felt like I was bouncing and such.

Kinda fun and kinda scary. I'm not sure if it was the Trileptal, I'm not sure if it was the fact that I had taken a percocet for my back a couple hours earlier....but it was freaking wierd.

I'm hoping the 900mg Trileptal plus the abilify and the lamictal will do the job...pdoc says he might take me off lamictal and just leave me Trileptal and Abilify as the Abilify seems to be doing its job well and we cut it back I had bad depression and self-harming impulses....so we'll see.

Anyone come off Depakote and go on Trileptal recently? I see this thread is from 2010.

Edited June 22, 2011 by PetSoundsFan

[Anna]

I tried it once, it didn't go so hot but I'm not sure I really gave it a fair trial. it's on my list to try again if my cholesterol keeps doing what it's doing, maybe, as i might have to take a statin, which is a no go w/dep. i really don't want to give up my dep, but man, my only other option is um, topamax, which i'm sort of scared of. i've tried everything else, including zonegran.

anna

[PetSoundsFan]

Well, after being off the depakote for a couple days, I'm beginning to see the bloating and constipation go away. Things are starting to move in the right direction. I just hope I feel as level and balanced on 900 mg of trileptal as I did on the 1000 mg of depakote because other than the weight gain/bloating and constipation, I was very pleased with depakote.

[snugglepuss]

I tried tapering off depakote because I want to start a family w/ my husband. When I got to 500 mg, the mood swings were frequent and bad. I even became psychotic a couple times under stress. I've decided I want to post-pone pregnancy and go back up on the depakote.

[lisasc63]

I had been on Depakote for over four years, up until a month ago. I had wanted to go OFF it for mainly the eight-gain side effect. So, my PDoc agreed I could "try" Trileptal, but he just told me to stop the Depakote, and start the Trileptal, gradually. He never told me to taper off the Depakote, just taper on the Trileptal. Well, about two weeks later, I was so manic and crazy, and it lasted about a week. Art first, of course it was kinda fun-i had not been so manic in years, basically since starting Depakote. After a week or so of sever mania that just escalated daily, I "crashed" into a deep dark depression. Well, like falling off a cliff, and SURVIVING, I say. After a week or so of the depression, I went into see My PDoc as a walk-in, and he told me just STOP, no taper-off, the Trileptal, and START, no taper-on, the Depakote. Well, it took a few days, and I felt a little better but by day 7, I was so manic again. I stayed up all night, took the next dose of Depakote early, and double my Trazadone, and i am still up now, the next day, and it is after 6 pm.

I called my PDoc's office three times, asking what to do, should I increase the Depakote, should I maybe be on Geodon, etc etc, until finally after NO return call, I just decided to take the Trileptal as I was originally directed, and I thought I would try to take BOTH Depakote and Trileptal. I am not sure if I should go back to that Doctor, as obviously even though I told his nurse I was so "sick" I was ready to go to the ER, but was hoping since I had just seen my PDoc a week ago, I could at least get a call back with some sort of directions. Needless to say, I still haven't slept, still feel shaky, dizzy and totally "out of it". If my PDoc had called back, I was going to cancel the appointment with the new Doctor, but I had been having the feeling I should find another Doctor anyway.

Anyone ever take Depakote AND Trileptal?? Anyone have better luck on something BESIDES Depakote ( and Lithium!)?? I have been on Serequel, Lamictil, Abilify, Respirdol, and I can't think of what else. That is just the mood stabilizers.

thanks for any help!

I am taking 1250 mg of Depakote, at bedtime, and the Trileptal was supposed to be 300 mg in the am and 600 mg at bedtime. I was taking Klonopin, 1mg, three times a day. Oh, and Vistiril, 50mg twice a day.

I am also taking Neurontin, 400mg, four times a day, Buspar, 30mg, twice a day, Trazadone, 150mg, at bedtime, celexa, 30mg, skipped today due to mania.

[crtclms]

Your avatar is my very favorite Van Gogh, I have it hanging in my bedroom.

There are a lot of people here who have trouble reading long walls of writing because of meds or their diagnoses. You will get a better response if you break it down into paragraphs. It was hard for me to read, but I will try to respond, sorry if I miss something.

Just so you know, Seroquel, Abilify, and Respiradal (sp?) are atypical anti-psychotics often used for mood stabilization. Usually, when someone here refers to mood stabilizers, they are referring to anti-convulsants and lithium.

Have you actually been able to give Trileptal a real chance? It sounds like your doctor was jerking you on and off meds so fast, that there is no real telling how it might work. Tri-leptal works for a lot of people. Tegretol is kind of the old school Tri-Leptal, I don't know what the actual differences are, but just wanted to throw the name out there.

Also, I don't recommend taking doses early, or doubling doses of any meds, let alone psych meds. That is not only not going to help, it could make things much worse.

So you can take more than one AC at the same time: I was on Depakote and Lamictal for a long time, and my husband is on Lamictal, Trileptal, and Lyrica at very high doses for his epilepsy.

The major mood stabilizer I see missing from your list is lithium. Was that ever tried?

ACs I notice missing from your list are topamax, and gabapentin. They are not really useful for a large group of people, but everyone is so different, you never know what will work for you. Topamax also has a "cousin," Zonegran. I have also heard of Keppra being used, but not often.

I feel like I am forgetting one that is going to embarrass me when someone points it out. But that is what I can come up with.

BUT, if nothing else works for you, while the Depakote did work, but made you gain weight, you may have to go back on Depakote, and really exercise like hell. It is possible to maintain, or even lose weight on Depakote, but it is not easy. I didn't do so, so I am not the model to look up to, but people on CBs have done it.

And to be honest, if you have a pdoc telling you to quit large amounts of an AC cold-turkey, you are right, it is time to start looking for a new pdoc. Avoiding a patient is not a good sign, either. Good luck with the new pdoc.

[gizmo]

I also have significant weight gain since starting depakote 9 months ago. But it totally killed my manias, and it's such a relief to not have to worry about those anymore that I'll take the weight gain. Mine is from the dep making me ravenously hungry (esp at night) and the fact that I don't exercise much to to my health problems and general depression and apathy I am suffering from right now.

I agree with the others - tapering off ACs is to be done slowly as to not freak out the brain. You build it up slowly when you start, it doesn't make sense that you quit it suddenly. I'd look for a new pdoc who is more informed about these things. One of the things I like about my pdoc is that he's only been out of school for a few years before I started to see him, and he's really progressive and up to date on current treatments and meds.

[Cattitude]

I was tapered off of Depakote onto Trileptal. The Depakote was prescribed to break a prolonged mixed episode, and it worked for that. However, it threw me into a deep depression and caused a lot of weight gain.

Once the Depakote was stopped and I was just on Trileptal, within a couple of days I developed a serious burning rash all over my body. I was also on Lamictal at the time, so pdoc told me to stop taking both. No more rash, then he put me on a low dose of Abilify.

[Bonita Martinez]

Im just now on Trileptal, Weenin off depokote...

I've been having tremors all nigh, Can not find rest. 

[crtclms]

Depakote gave me a bad tremor. Hopefully that is what's flaring up, and it will be over in a couple of weeks.

[browri]

On 6/22/2011 at 0:25 PM, PetSoundsFan said:

I was put on Depakote and got up to 1000 mg. The weight gain and constipation was incredible. Last month the pdoc had me taper down to 500 mg as we were going to switch to something else. Up until Monday, I was on 500 mg for the last two weeks and I really noticed a difference...cycling, started to feel very anxious and manicy as well as some beginning signs of depression.

 

On Monday I cut the depakote out and began 150 mg of Trileptal in the morning and 300 mg in the evening. On Saturday I'll go to 300 mg in the morning and 600 mg in the evening. Last night I lied down to go to sleep, closed my eyes and saw, as clearly and perfectly as if it were real, me driving a big truck from my point of view..that is, I didn't see it in third person. My body shook as if I were driving a big Uhaul...I don't think I physically shook but I felt like I was bouncing and such.

 

Kinda fun and kinda scary. I'm not sure if it was the Trileptal, I'm not sure if it was the fact that I had taken a percocet for my back a couple hours earlier....but it was freaking wierd.

 

I'm hoping the 900mg Trileptal plus the abilify and the lamictal will do the job...pdoc says he might take me off lamictal and just leave me Trileptal and Abilify as the Abilify seems to be doing its job well and we cut it back I had bad depression and self-harming impulses....so we'll see.

 

Anyone come off Depakote and go on Trileptal recently? I see this thread is from 2010.

 

On 8/11/2010 at 0:26 AM, dolcebellaluna said:

I saw my p-doc a week ago and confronted him about the weight I've gained over the past year, after stopping Lithium and then trying Seroquel, Zyprexa, and finally Depakote. I've gained about 50 pounds without any change in eating habits or exercise and I decided that I'd had enough of it! I talked to my p-doc and he told me we could lower my dose of 1500 mg Depakote daily to 1000 mg daily for 6 weeks. I wanted to be started up on another mood stabilizer in the meantime, but he didn't like the idea and said we could re-consider it at our next appointment. No less than two days after I started taking the lower dose, I felt like all of my soft signs of depression were lurking at every corner.

 

 

 

• Increased sleep
• Decreased appetite and sex drive
• Low motivation and poor concentration
• Poor self image
• Increased tearfulness and irritability

After 5 days of this, I attributed these feelings to my bi-polar illness relapsing after not being masked anymore by the Depakote. I saw my p-doc again today and begged him to put me on something in the meantime. He was curt and impersonable with me and printed out the prescription without even talking to me. I had to run back in the office and ask him when he wanted to see me again to see if the Trileptal is working. He put me on 300 mg of Trileptal twice a day and said he'll see me in 3 weeks. He didn't tell me to stop my Depakote taper, but I wish I could. I don't see how being on two anti-convulsants makes much sense.

 

Has anyone else ever tapered off of Depakote and onto something else simultaneously? Does this picture sound right?

Interesting thing. Valproate actually reduces the levels of MHD which is the oxcarbazepine metabolite in Trileptal that does all the work. In clinical trials it reduced levels by up to 30%. So 600mg a day is more like 300-450. I guess that explains why he started you off right at 600mg. Normally starting at 150mg and slowly working up would have felt like a placebo.

On 6/23/2011 at 9:48 AM, PetSoundsFan said:

Well, after being off the depakote for a couple days, I'm beginning to see the bloating and constipation go away. Things are starting to move in the right direction. I just hope I feel as level and balanced on 900 mg of trileptal as I did on the 1000 mg of depakote because other than the weight gain/bloating and constipation, I was very pleased with depakote.

Per what I said above, as the valproate slowly leaves your body, your MHD levels will also slowly increase as they aren't being induced by the valproate as much. Which means 900mg of Trileptal will continue to go a long way. If you want to take it once a day and your insurance will cover it. There's Oxtellar XR. It's like Depakote where extended release needs to be dosed higher than the immediate release. I was taking 900mg of Trileptal for 6-9 months before I switched to the extended release at which point I went up to 1200mg. Was a bit of a doozy for the first few days because it was a bit higher than just compensating for the XR but it leveled out.

Funny enough. I actually just switched in the opposite direction from Oxtellar XR to Depakote because I needed a stronger anti-manic component in my cocktail. But if I develop any sort of systemic issues like liver problems I will automatically go straight back to it. Before Oxtellar/Trileptal I was on Lamictal which was good for the mood swings and fairly good for the depression but it just wasn't calming enough.