Sodium valproate + other med questions

[papertrees]

Hi,

so I came from my pdoc's office after a series of mixed episodes and walked out with a brand-new script for Valpros, which is essentially sodium valproate + valproic acid, 500mg for 1 week, to be increased to 1000mg next week.

I took my first dose about 3 hours ago and I'm so, so tired and lethargic.

I cannot, cannot get out of bed (I'm in bed now!).

I feel like crap.

Does this ever go away? If so, how long do I have to put up with this?

I am (currently, at least) a freelance writer. I need mental clarity and creativity at my so-called job.

What other side effects can I expect?

I am atypical when it comes to my responses to meds, in that I did not gain weight on weight-gainer drugs such as Zyprexa, lithium and Remeron. (Although I am starting to feel carb cravings in Zydis now, but my pdoc said it could be mood-related at this point, since I have been on Zydis for three months and have not gained).

My Lamictal dosage was also halved to 125mg, since Valpros decreases clearance of lamotrigine. I'm just scared that I'm dipping into depression since I feel so crappy.

Would adding an antidepressant at this point help? If so, what antidepressant might I suggest?

And, last question (and I'm asking this because me and my pdoc are really at a loss):

Would exchanging Zyprexa for haldol be a good idea?

Zyprexa makes me too damn lethargic and tired. We're thinking 2.5mg of haldol for starters, since I found myself an utter drooling zombie at 5mg. I've tried all the atypicals, including depots. Nothing has touched my delusions except Zyprexa, but I can't function at my job because of the sedation. We're not tweaking the AP yet because we're stabilizing the mood stabilizer first, but we're considering haldol. Is it a wise move, should we choose it? Anyone on the same boat? Or on a similar cocktail?

ETA: I also have a script for Xanax. for emergency. If that means anything.

I apologize for the long post. Really. I just needed to let it all out.

Thank you.

[Guest Vapourware]

To be honest, none of us can advise on what antidepressant drugs you should take, or whether you should definitely swap Zyprexa for Haldol - they're more for your pdoc to answer than us, since he has the professional training and a better knowledge of your history.

As for sodium valproate - personally I never had lethargy while on it, although I think lethargy is noted on the PI sheet as a possible side effect. Given that you've just started, there's a good chance that once your body gets used to it, then it would go away. I took 1000mg for about two years and didn't feel lethargic or fatigued while on it.

Other side effects that I received - which may or may not happen to you, as each medication acts differently on people - was some hair loss [which was not outwardly noticeable, only noticeable when I was brushing my hair or towel-drying my hair after a shower], and slight weight gain.

[gizmo]

I've been on depakote ER for the past several months, and it has really improved things for me.

I gained weight on zyprexa; I'm currently on a low dose of topamax to see if it fights the intense urges to eat, esp. at night. Depakote hasn't made me tired, so it may just take you a few days to get used to it.

[papertrees]

Ok. I've just been tired of running the med-go-round.

Plus I really am quite sure I've got some form of personality disorder (borderline) which my pdoc refuses to acknowledge. (I should mention that my former pdoc diagnosed me as such before).

Anyway, I am tired and fatigued. That could be due to the Valpros or to my moods running all over the place.

Thanks.

[renaeden]

I had a definite problem with tiredness on valproate at first and so had to drop my dose as I could barely function being that tired. But I am gradually increasing the dose again and it hasn't been too bad. Maybe your dose needs to be increased more slowly.

I was on haloperidol for two years but that was for tics. I quit it because of the side effects. Am now considering something else.

[Anna]

Yes we can't give you advice on meds. I would say that if you've tried all the atypicals there is really nothing WRONG with trying the typicals. There is a slight risk of increased movement disorders, but then on the atypicals you have other risks. Plenty of people do well on the typcals.

With depakote, which I've been on for several years, I'd say give it a few days. The lethargy may well wear off. Are you on the ER version? If so, and the lethargy does NOT wear off, you could try the immediate release version, taking it all at night, and see if there is less lethargy throughout the day.

Sorry to hear about your problems with meds, hope things improve.

Anna

[papertrees]

I might be giving clozapine a try tomorrow.

Pdoc said so.

I'll update tomorrow morning.

[Anna]

Good luck, papertrees.

Anna

[papertrees]

I am on my first day of clozapine.

I feel drugged and lethargic, but without appetite.

I'm afraid of the weight gain. But if this appetite (or lack of it) continues, then maybe it won't be a problem?

I was also started on metformin.

What do you think?

[netsavy006]

Just curious: are you cross titrating (meaning you increase the clozapine at the same time as decreasing the zyprexa) or did you completely stop the Zyprexa and start clozapine?

[papertrees]

I had to stop zyprexa completely because i ran out of it.

I feel okay today.

Appetite is controlled.

I don't feel drugged.

And I haven't drooled.