Valproate vs Lithium

[rachael]

I saw my new (very nice) pdoc today (I have moved) and he brought up changing mood stabilizers, so I wanted to hear some opinions from people here.

 

We had the long intake talk, he agrees with previous diagnosis (BP1) but was a bit surprised that I would be on Valproate since he thinks Lithium would be more appropriate for me since I had very serious episodes and he thinks Lithium is generally more effective than Valproate. He also said that since I had one break through mania on Valproate, I might need a stronger anti-manic and going higher on Valproate is not really an option since I'm on the mid-high of the therapeutic range. He said we should re-evaluate when we meet next but just put the thought out there. He wasn't pushing towards changing and said if it works and I'm happy, he's ok to keep me on what I am on.

 

I have few side effects on Valproate. My main concern is cognitive impairment, which I only have on Valproate when I miss a dose or drink alcohol.  He said that cognitive impairment is generally due to sedation, so he does not think it would be an issue on Lithium. According to him, the most common complaint he gets about Lithium is that it takes away the mania and people miss it.   I get that, but that's  a "side effect" of Valproate too. 

 

I know, none of you are medical doctors out there, YMMV and so on, but any second opinions? Is Lithium really the better anti-manic? Does it take away the mild highs too? How is it on the depressive side? What about creativity? Sex drive? Do you like your Lithium?

[Vipress]

I take 1500mg lithium (600mg morning, 900mg at night) its a high dosage but they have to do regular blood work so it shows up therapeutically different for everyone... I went undiagnosed for a years for my bipolar and it took a while to get on the right level of lithium but it has been a miracle for me... the only current staple to my medication plan that works great. Has not effected my creativity, sex drive, or caused me to be more or less depressed tho. As for mild highs, definitely. But just my opinion.

[mcjimjam]

I haven't taken valproate, so I can't compare them. I haven't had any manic episodes since taking lithium. If by "mild highs" you mean some kind of hypomania, then yes, lithium has taken that away for me. For depression, I think it has decreased my suicidal impulses and enabled antidepressants to work. I don't think it has affected my sex drive or creativity and I do like it.

[mynameisiforgot]

I have been on both and I believe Lithium is way better.

[crtclms]

I've taken valproate for migraines, not my mood, and it had no effect on my mood. I am on a low dose of lithium (an "add on") to help with depression that wasn't quite being treated with the lamictal and wellbutrin. I like it.

 

Lithium does tend to be the go to med for BP I. I don't have many side effects, I just have to drink a shit-ton of water. But I did that in any case. Some people gain weight, but that has not been the case for me, at all. I've lost weight, although I don't think it is related to the lithium.

[San]

I much prefer Lithium. I can't take it due to kidney stuff, but it is fantastic. Lithium was the first approved drug and the only true "mood stabilizer" out there. You do have to deal with drug tests, and do have to drink a lot of water (or electrolyte drinks) and avoid NSAID's (prolonged use can raise lithium levels, however, once in a while isn't that bad, ask your doctor) as well as cut back a bit with caffeine.

 

With both, you need blood tests, but moreso with Lithium.

 

I consider it the best, but unfortunately, I can't take it. If I could, you bet your ass I would!