Caddy Posted October 1, 2019 Share Posted October 1, 2019 (edited) I am interested in hearing from people who take low doses of Depakote. Say, under 500 mg daily. At 1000 mg daily, Depakote turned me into a zombie and completely numbed my emotions. However, I did really appreciate the way it seemed to hold my thoughts together and keep me calm. I am considering adding a baby dose of Depakote, such as 250 mg daily, in addition to other meds. I'm thinking 125 mg x 2. As I may be adding a stimulant at some point, or at least bupropion, I feel like it may be beneficial. I did find at least one study that showed positive results for bipolar patients taking 250-500 mg daily. https://www.ncbi.nlm.nih.gov/pubmed/8331092 Anybody? Edited October 1, 2019 by Caddy Link to comment Share on other sites More sharing options...
Will Posted October 1, 2019 Share Posted October 1, 2019 I took it for awhile in 2012 during acute mania. Can't remember the dosage but it probably helped. But my mania is so severe that it's hard to judge. I don't remember being a zombie, just that it did not go to psychosis. I'd link the study in this thread and you'll probably get replies regrading it. Link to comment Share on other sites More sharing options...
Caddy Posted October 1, 2019 Author Share Posted October 1, 2019 11 minutes ago, Will said: I'd link the study in this thread and you'll probably get replies regrading it. Linked. Link to comment Share on other sites More sharing options...
Iceberg Posted October 1, 2019 Share Posted October 1, 2019 What else are you taking that you want to add it too? I feel that low dose add one can definetly be helpful but work much better if you already have a decent base cocktail Link to comment Share on other sites More sharing options...
Caddy Posted October 1, 2019 Author Share Posted October 1, 2019 I am currently taking Seroquel XR 300 mg, and I would say it is working well. I think adding the baby dose of Depakote to this would be a nice mood stabilizing package for me. My depression manifests as severe fatigue and cognitive issues, mostly. I want to try some activating meds to combat this, but I want to have that security blanket in place to deal with any anxiety or mood symptoms that may arise. I envision a core like this: Wellbutrin XL 300 Seroquel XR 300 Depakote DR 250 Viibryd/Trintellix baby dose Then, if I am still struggling with energy and concentration, I would consider adding a low dose of amphetamine such as Vyvanse. To be more specific about my condition... I am bipolar, but I'm not too bad. I actually enjoyed my condition when it was more mild, but that's probably why it has progressively worsened. I used to really ride those highs and lows. Knowing what I know now, I'm sure that played a role in my emotions becoming more and more extreme. Link to comment Share on other sites More sharing options...
mikl_pls Posted October 1, 2019 Share Posted October 1, 2019 14 minutes ago, Caddy said: My depression manifests as severe fatigue and cognitive issues, mostly. Depakote will definitely worsen these symptoms. Link to comment Share on other sites More sharing options...
Caddy Posted October 1, 2019 Author Share Posted October 1, 2019 2 minutes ago, mikl_pls said: Depakote will definitely worsen these symptoms. Well, this is the reason I am considering such a small dose. Don't pretty much all of the mania drugs slow you down a little bit? Link to comment Share on other sites More sharing options...
mikl_pls Posted October 1, 2019 Share Posted October 1, 2019 Just now, Caddy said: Well, this is the reason I am considering such a small dose. Don't pretty much all of the mania drugs slow you down a little bit? I don't know about 250 mg, but I was on 500 mg for just two weeks and had terrible cognitive and memory issues. I had no recollection of those two weeks whatsoever. After I stopped it, my cognition and memory returned to "baseline," which is pretty poor as it is. Just my experience though, YMMV. Yes they can, except for lithium, which actually improves cognition to a degree (low doses anyway, I believe). The anticonvulsant mood stabilizers definitely all can have an impact on cognition and memory but to varying degrees from one med to another. E.g., Topamax and Depakote will definitely have more adverse effects than something like Lamictal, or even Trileptal or Tegretal. Link to comment Share on other sites More sharing options...
Caddy Posted October 1, 2019 Author Share Posted October 1, 2019 12 minutes ago, mikl_pls said: I don't know about 250 mg, but I was on 500 mg for just two weeks and had terrible cognitive and memory issues. I had no recollection of those two weeks whatsoever. After I stopped it, my cognition and memory returned to "baseline," which is pretty poor as it is. Just my experience though, YMMV. Another member on this site credited valproate with allowing him to tolerate stimulants, because he said that otherwise they spin him out too much as far as anxiety. I guess that is the way I am looking at it. I am concerned that I may need something to take the edge off in order for me to tolerate long term treatment with medications such as bupropion and dextroamphetamine. It may be a net win overall, despite the downsides you have stated. Link to comment Share on other sites More sharing options...
Iceberg Posted October 1, 2019 Share Posted October 1, 2019 3 minutes ago, Caddy said: Another member on this site credited valproate with allowing him to tolerate stimulants, because he said that otherwise they spin him out too much as far as anxiety. I guess that is the way I am looking at it. I am concerned that I may need something to take the edge off in order for me to tolerate long term treatment with medications such as bupropion and dextroamphetamine. It may be a net win overall, despite the downsides you have stated. Could you do a small seroquel bump instead? Link to comment Share on other sites More sharing options...
Caddy Posted October 1, 2019 Author Share Posted October 1, 2019 1 minute ago, Iceberg said: Could you do a small seroquel bump instead? I've considered it. I guess I'm just not optimistic because I am just now starting to get over the sedation and brain fog of Seroquel. I know people say it becomes more activating at higher doses, and I can vouch that 300 mg is definitely way less sedating than 25 or 50 mg. I can't imagine being super mentally sharp on a high dose of Seroquel, though. For some reason I like the idea of taking smaller doses of multiple meds. I dunno. Link to comment Share on other sites More sharing options...
Iceberg Posted October 1, 2019 Share Posted October 1, 2019 Just now, Caddy said: I've considered it. I guess I'm just not optimistic because I am just now starting to get over the sedation and brain fog of Seroquel. I know people say it becomes more activating at higher doses, and I can vouch that 300 mg is definitely way less sedating than 25 or 50 mg. I can't imagine being super mentally sharp on a high dose of Seroquel, though. For some reason I like the idea of taking smaller doses of multiple meds. I dunno. Yeah I have had a few docs who are big fans of that strategy of mixed low meds...Seroquel might be better for depression than Depakote in the long run though 1 Link to comment Share on other sites More sharing options...
argh Posted October 2, 2019 Share Posted October 2, 2019 (edited) . Edited September 20, 2020 by argh Link to comment Share on other sites More sharing options...
Caddy Posted October 2, 2019 Author Share Posted October 2, 2019 1 hour ago, argh said: Are you bipolar 1 or 2 I find it hard to draw a line. With that said, I feel that I just recently experienced true mania for the first time. It's like the euphoria has been replaced with irritability, anxiety, akathisia, etc. Now I have crashed and have not been able to get out of bed for months. This is all new to me. Link to comment Share on other sites More sharing options...
Iceberg Posted October 2, 2019 Share Posted October 2, 2019 1 minute ago, Caddy said: I find it hard to draw a line. With that said, I feel that I just recently experienced true mania for the first time. It's like the euphoria has been replaced with irritability, anxiety, akathisia, etc. Now I have crashed and have not been able to get out of bed for months. This is all new to me. Well true mania makes it BP1 (if the true mania is Dxd of course) but seroquel and Depakote are both indicated to BP 1 mania, while only seroquel is geared towards the depression. However Depakote is of course a mood stabilizer which can help depression Too, but I think it is less common for acute depressive episodes...although I’m sure people on here have tried it for that. I am not trying to push the seroquel just saying that adding the Depakote might reignite some of the cognitive/sluggishness issues. for what it’s worth, IR seroquel is used off label for anxiety Link to comment Share on other sites More sharing options...
Caddy Posted October 2, 2019 Author Share Posted October 2, 2019 4 minutes ago, Iceberg said: Well true mania makes it BP1 (if the true mania is Dxd of course) but seroquel and Depakote are both indicated to BP 1 mania, while only seroquel is geared towards the depression. However Depakote is of course a mood stabilizer which can help depression Too, but I think it is less common for acute depressive episodes...although I’m sure people on here have tried it for that. I am not trying to push the seroquel just saying that adding the Depakote might reignite some of the cognitive/sluggishness issues. for what it’s worth, IR seroquel is used off label for anxiety Seroquel's indication for depression is interesting. While I do think it lifts my mood a bit, I feel like it holds me back as far as energy and productivity. It doesn't help me get out of bed, it just makes me more content with laying here. I like Seroquel for the effect it has on my paranoia and insomnia. Any anti-depressant effect is just a bonus. Link to comment Share on other sites More sharing options...
Iceberg Posted October 2, 2019 Share Posted October 2, 2019 10 minutes ago, Caddy said: Seroquel's indication for depression is interesting. While I do think it lifts my mood a bit, I feel like it holds me back as far as energy and productivity. It doesn't help me get out of bed, it just makes me more content with laying here. I like Seroquel for the effect it has on my paranoia and insomnia. Any anti-depressant effect is just a bonus. Yeah I actually feel the same way about it sometimes being too sedating to really help depression Link to comment Share on other sites More sharing options...
argh Posted October 2, 2019 Share Posted October 2, 2019 (edited) . Edited September 20, 2020 by argh Link to comment Share on other sites More sharing options...
mikl_pls Posted October 2, 2019 Share Posted October 2, 2019 I agree with lamotrigine being ideal for depressive episodes. Also, if you want to remain on an AAP, maybe ask to try something different than Seroquel? Something energizing like Abilify? (If you haven't already tried it that is...) Link to comment Share on other sites More sharing options...
Iceberg Posted October 2, 2019 Share Posted October 2, 2019 Both good options - I didn’t suggest an activating aap because you were worried about caping anxiety ... lamictal is good for BP depression as said above, but I didn’t get much of a calm effect- and the start up can be rough Link to comment Share on other sites More sharing options...
Caddy Posted October 2, 2019 Author Share Posted October 2, 2019 If I start taking Wellbutrin, Viibryd, and Vyvanse... I don't think I will need any more activation. I'm going to need something to level me out. My current Seroquel dosage may or may not be enough. I suppose the real question here is: how much sedation do I need? To be honest, if I could just spend the rest of my life in a hypomanic state, that would be perfect. I'm okay with being a little bit eccentric, as long as I don't get too wild. Link to comment Share on other sites More sharing options...
Iceberg Posted October 2, 2019 Share Posted October 2, 2019 1 minute ago, Caddy said: If I start taking Wellbutrin, Viibryd, and Vyvanse... I don't think I will need any more activation. I'm going to need something to level me out. My current Seroquel dosage may or may not be enough. I suppose the real question here is: how much sedation do I need? To be honest, if I could just spend the rest of my life in a hypomanic state, that would be perfect. I'm okay with being a little bit eccentric, as long as I don't get too wild. Be careful - your talking about a lot of med changes there. All that stuff will need to be spread out over time and done one by one Link to comment Share on other sites More sharing options...
mikl_pls Posted October 2, 2019 Share Posted October 2, 2019 1 hour ago, Iceberg said: Be careful - your talking about a lot of med changes there. All that stuff will need to be spread out over time and done one by one I agree, making too many med changes at once may lead to overmedication. My pdoc makes generally two changes at a time max unless she thinks the risk outweighs the benefit. 1 hour ago, Caddy said: If I start taking Wellbutrin, Viibryd, and Vyvanse... I don't think I will need any more activation. I'm going to need something to level me out. My current Seroquel dosage may or may not be enough. You may want to start with Viibryd first since you deal with anxiety, then start either Wellbutrin or Vyvanse (one at a time as they will boost each others' effects, and starting one at a time decreases the chances of overstimulation, thereby reducing your need to increase the Seroquel dose). 1 hour ago, Caddy said: I suppose the real question here is: how much sedation do I need? To be honest, if I could just spend the rest of my life in a hypomanic state, that would be perfect. I'm okay with being a little bit eccentric, as long as I don't get too wild. I think rather than asking how much of a side effect you need from a medicine, it's better to ask how much of a therapeutic effect can you get from the med with as little side effects possible at the lowest effective dose. This again can be achieved by efficient medicine management. Link to comment Share on other sites More sharing options...
Caddy Posted October 2, 2019 Author Share Posted October 2, 2019 Yeah, I have no intention of starting all of those meds at once. I'm just thinking long term. Viibryd and Trintellix will not even be options until I get insurance. At the moment, I am going to a free clinic and using GoodRx coupons. I am currently taking 10 mg of Paxil, but I don't see it as a long term option. I might stay on it until I have access to Viibryd/Trintellix, or I might try Zoloft before then. Either way, I think my next move will be to add Wellbutrin and see how it affects me. If I am able to tolerate it, it just might be the ideal AD for me. If I do add an amphetamine, that would come last, after the rest of my cocktail has been established. 6 hours ago, mikl_pls said: I think rather than asking how much of a side effect you need from a medicine, it's better to ask how much of a therapeutic effect can you get from the med with as little side effects possible at the lowest effective dose. This again can be achieved by efficient medicine management. I was just being blunt because it seems like "sedating" and "anti-manic" are pretty much synonymous. Link to comment Share on other sites More sharing options...
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