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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by ST on February 6, 2002, at 2:56:04
Hi,
My pdoc now has me on what he calls a "maintenance" level of Depakote (500 mg daily). I've never shown any signs of severe mania during or before being medicated. Before I started taking the Deapkote and ADs, I fluctuated between moderate to severe depression and hypomania. Mostly depression. Now I'm surprised to learn that there are actually bi polars out there who are on a small amount of Depakote or another mood stabilizing drug and manage just fine. I've always felt as if I was on "too much" Depakote, but dismissed the thought of further reducing my dosage as my being irresponsible.
The Depakote has been like a wet blanket sitting on top of my emotions, reflexes, creativity, motivation - everything. I've been on this level for over 3 weeks now and I feel like the blanket has been lifted. I'm sleeping 8 to 9 hours a night, I'm able to focus, I don't feel as though my thoughts are racing or that people aren't moving as fast as me. Just level. And alert. I've been instructed to call my pdoc asap if I feel hypomanic and my boyfriend is going to keep an eye on me.
In no way am I saying that mood stabilizers are not necessary if one has been diagnosed as bi polar. I do understand that the manic or hypomanic phase is one in which most bi polars would like to stay despite it's danger. Will I become hypomanic and refuse to up my dosage? I simply want my emotions, my wit, my physical energy and my creativity back.
Is anyone on a "maintenance" level of Depakote or Lithium? Can this really work?
Thanks!
Sarah
Posted by tina on February 6, 2002, at 7:55:23
In reply to Any bi polars on a maintenance dose of Depakote?, posted by ST on February 6, 2002, at 2:56:04
I'm taking 250mgs a day. I tried to go higher but it just wasn't good for me. I'm sure a maintenance dose will be just fine for you. If you feel good one it, stick with it.
~~~~~~~~~~~~~~~~~~~~~~
> Hi,
>
> My pdoc now has me on what he calls a "maintenance" level of Depakote (500 mg daily). I've never shown any signs of severe mania during or before being medicated. Before I started taking the Deapkote and ADs, I fluctuated between moderate to severe depression and hypomania. Mostly depression. Now I'm surprised to learn that there are actually bi polars out there who are on a small amount of Depakote or another mood stabilizing drug and manage just fine. I've always felt as if I was on "too much" Depakote, but dismissed the thought of further reducing my dosage as my being irresponsible.
>
> The Depakote has been like a wet blanket sitting on top of my emotions, reflexes, creativity, motivation - everything. I've been on this level for over 3 weeks now and I feel like the blanket has been lifted. I'm sleeping 8 to 9 hours a night, I'm able to focus, I don't feel as though my thoughts are racing or that people aren't moving as fast as me. Just level. And alert. I've been instructed to call my pdoc asap if I feel hypomanic and my boyfriend is going to keep an eye on me.
>
> In no way am I saying that mood stabilizers are not necessary if one has been diagnosed as bi polar. I do understand that the manic or hypomanic phase is one in which most bi polars would like to stay despite it's danger. Will I become hypomanic and refuse to up my dosage? I simply want my emotions, my wit, my physical energy and my creativity back.
>
> Is anyone on a "maintenance" level of Depakote or Lithium? Can this really work?
>
> Thanks!
> Sarah
Posted by Krazy Kat on February 6, 2002, at 12:04:40
In reply to Any bi polars on a maintenance dose of Depakote?, posted by ST on February 6, 2002, at 2:56:04
My God, I am in the exact same situation as you are, except I am choosing to keep my Dep. level at 500 mg - my pdoc wants it at 1000.
Everything you said about Dep. has been true for me at 1000 - a "flatness" which my pdoc does not understand. (?) This last time, an extreme depression in which I had very bad suicidal tendencies.
I'm diagnosed with severe depression and hypomania, too, though sometimes I also have psychotic symptoms.
My pdoc feels that Depakote is only for acute mania, and it works fabulously for me, very quickly, when I get either hypomanic or severly agitated and depressed.
So why can't it also work at a therapeutic dose? I don't know how else to tell him that I feel better at 500 mg Dep., and, currently, 60 mg Prozac.
I am going to tell him someone else is being treated this way!! :)
Anyhoo, it's only been about a week and half for me, but it's working well thus far. I know there are others on a "lower" dose here as well. I did feel a little hypomanic yesterday, but nothing I could not handle. Today I'm actually a little tired.
Good luck!
- KK
Posted by Chloe on February 6, 2002, at 18:24:09
In reply to Any bi polars on a maintenance dose of Depakote?, posted by ST on February 6, 2002, at 2:56:04
> Is anyone on a "maintenance" level of Depakote or Lithium? Can this really work?
>Yes, I have been on both. And I would say, yes, they work, if I stay on them! I am finding I always have to be on some mood stabilizer, or my walls start to crumble and my life falls apart. But, when I am on this maintenance dose, I start to think, "Gee, I haven't been hypomanic/agitated in weeks, (months, whatever) and my temper is really under control. I wonder if I really needs these meds, I feel kinda dull?..."
Well, I do. I am hoping I remember that the next time I think I can go off the mood stabilizer. Currently I am on 250 mgs Depakote, 400 mgs Neurontin. Seems to being doing the trick so far. I think the neurontin is help preventing some of the depakote "flatness." But not sure...
Feeling blah is the pits. But the uncontrolled highs and lows can be pretty awful too, and to the ones I love.
Take care,
Chloe
Posted by ST on February 6, 2002, at 21:18:47
In reply to Re: Any bi polars on a maintenance dose of Depakote? » ST, posted by Krazy Kat on February 6, 2002, at 12:04:40
KK,
Good to know others are on low doses as well. There are people who are at only 250 mgs? Go figure. I thought this was such a "risky" thing for me to be telling my doctor I wanted to do.
> I am choosing to keep my Dep. level at 500 mg - my pdoc wants it at 1000. >
So why does he want you at 1000? Why does he feel you can't make a choice about this? Are you going to work/school? Do you have good relationships with those close to you? If you're high functioning, you should be able to make these medication decisions. There are a lot of bi polars, I guess, who just like the "up" feeling and choose to lower their doses even though it isn't for their highest good. But there are some who have good reasoning abilities and do want to do what's best for their mental health, yet want to have a life as well.
> My pdoc feels that Depakote is only for acute mania, >Supposedly it is. Lithium is what they usually use for maintenance. Depakote is not FDA approved to be used as such. However, my pdoc told me he was just at a bi polar lecture/seminar thingy and other doctors were talking about how Depakote IS used quite successfully for maintenace. He has other patients who are doing it. His peers are prescribing it for maintenance.
> So why can't it also work at a therapeutic dose? I don't know how else to tell him that I feel better at 500 mg Dep., and, currently, 60 mg Prozac. >
If you were to test your levels, perhaps it wouldn't be a "therapeutic" dose for you. I was tested over the summer while on 750 mg of Depakote and came up at a waaaaaay sub-therapeutic level. But, again, my doctor says just because the numbers say one thing, doesn't mean the result is subsequently going to be a textbook example. He told me many bi polars are at "sub-therapeutic" levels and do just fine. I would ask him why he feels you are not able to make such a choice.
I was a baaaaad girl. I went down from 750 to 500 about three weeks ago on my own. At first I forgot to take my morning dose. Then another. Then another. When I realized this, I said to myself: "Let's see what happens if I stop that morning dose altogether..." So I did. And I feel like I'm living again. I then went in to my pdoc's office with a list of my traits and moods over the past three weeks at 500 mg. He couldn't argue. Obviously I was not hypomanic and I was functioning at a clearer, more alert level.
I say stay at 500 mg for a couple of weeks and see how you feel. Then maybe go in to your doctors office armed with a journal of your moods after being on 500 mg.Let me know what happens!
Sarah
Posted by Chloe on February 7, 2002, at 19:23:03
In reply to Re: Any bi polars on a maintenance dose of Depakote?, posted by ST on February 6, 2002, at 21:18:47
> KK,
>
> Good to know others are on low doses as well. There are people who are at only 250 mgs? Go figure. I thought this was such a "risky" thing for me to be telling my doctor I wanted to do.
>
> > I am choosing to keep my Dep. level at 500 mg - my pdoc wants it at 1000. >
>
> So why does he want you at 1000? Why does he feel you can't make a choice about this? Are you going to work/school? Do you have good relationships with those close to you? If you're high functioning, you should be able to make these medication decisions. There are a lot of bi polars, I guess, who just like the "up" feeling and choose to lower their doses even though it isn't for their highest good. But there are some who have good reasoning abilities and do want to do what's best for their mental health, yet want to have a life as well.
>
>
> > My pdoc feels that Depakote is only for acute mania, >
>
> Supposedly it is. Lithium is what they usually use for maintenance. Depakote is not FDA approved to be used as such. However, my pdoc told me he was just at a bi polar lecture/seminar thingy and other doctors were talking about how Depakote IS used quite successfully for maintenace. He has other patients who are doing it. His peers are prescribing it for maintenance.
>
> > So why can't it also work at a therapeutic dose? I don't know how else to tell him that I feel better at 500 mg Dep., and, currently, 60 mg Prozac. >
>
> If you were to test your levels, perhaps it wouldn't be a "therapeutic" dose for you. I was tested over the summer while on 750 mg of Depakote and came up at a waaaaaay sub-therapeutic level. But, again, my doctor says just because the numbers say one thing, doesn't mean the result is subsequently going to be a textbook example. He told me many bi polars are at "sub-therapeutic" levels and do just fine. I would ask him why he feels you are not able to make such a choice.
>
> I was a baaaaad girl. I went down from 750 to 500 about three weeks ago on my own. At first I forgot to take my morning dose. Then another. Then another. When I realized this, I said to myself: "Let's see what happens if I stop that morning dose altogether..." So I did. And I feel like I'm living again. I then went in to my pdoc's office with a list of my traits and moods over the past three weeks at 500 mg. He couldn't argue. Obviously I was not hypomanic and I was functioning at a clearer, more alert level.
> I say stay at 500 mg for a couple of weeks and see how you feel. Then maybe go in to your doctors office armed with a journal of your moods after being on 500 mg.
>
> Let me know what happens!
>
> SarahHi
I don't think one can go by the # of milligrams to determine a maintenance dose. Everyone metabolizes medications differently. 250 mgs for one person might be equivalent to 1000 mgs to another person's system. And it's also important to take into account a person's size, sensitivity to drugs and how much AD a person is taking along with the depakote.So I would be careful not to get too hung up on the number of milligrams. But focus on the right amount of medication to be emotionally stabile and in control, without the loss of (too much!) quality of life.
Best,
Chloe
Posted by ST on February 7, 2002, at 20:28:36
In reply to Re: Any bi polars on a maintenance dose of Depakote? » ST, posted by Krazy Kat on February 6, 2002, at 12:04:40
KK,
Good to know others are on low doses as well. There are people who are at only 250 mgs? Go figure. I thought this was such a "risky" thing for me to be telling my doctor I wanted to do.> > I am choosing to keep my Dep. level at 500 mg - my pdoc wants it at 1000. >
So why does he want you at 1000? Why does he feel you can't make a choice about this? Are you going to work/school? Do you have good relationships with those close to you? If you're high functioning, you should be able to make these medication decisions. There are a lot of bi polars, I guess, who just like the "up" feeling and choose to lower their doses even though it isn't for their highest good. But there are some who have good reasoning abilities and do want to do what's best for their mental health, yet want to have a life as well.
> > My pdoc feels that Depakote is only for acute mania, >Supposedly it is. Lithium is what they usually use for maintenance. Depakote is not FDA approved to be used as such. However, my pdoc told me he was just at a bi polar lecture/seminar thingy and other doctors were talking about how Depakote IS used quite successfully for maintenace. He has other patients who are doing it. His peers are prescribing it for maintenance.
> > So why can't it also work at a therapeutic dose? I don't know how else to tell him that I feel better at 500 mg Dep., and, currently, 60 mg Prozac. >
If you were to test your levels, perhaps it wouldn't be a "therapeutic" dose for you. I was tested over the summer while on 750 mg of Depakote and came up at a waaaaaay sub-therapeutic level. But, again, my doctor says just because the numbers say one thing, doesn't mean the result is subsequently going to be a textbook example. He told me many bi polars are at "sub-therapeutic" levels and do just fine. I would ask him why he feels you are not able to make such a choice.
I was a baaaaad girl. I went down from 750 to 500 about three weeks ago on my own. At first I forgot to take my morning dose. Then another. Then another. When I realized this, I said to myself: "Let's see what happens if I stop that morning dose altogether..." So I did. And I feel like I'm living again. I then went in to my pdoc's office with a list of my traits and moods over the past three weeks at 500 mg. He couldn't argue. Obviously I was not hypomanic and I was functioning at a clearer, more alert level. I say stay at 500 mg for a couple of weeks and see how you feel. Then maybe go in to your doctors office armed with a journal of your moods after being on 500 mg.
Let me know what happens!
Sarah
Posted by spike4848 on February 8, 2002, at 0:47:35
In reply to Re: Any bi polars on a maintenance dose of Depakote? » Krazy Kat, posted by ST on February 7, 2002, at 20:28:36
Hey There,
Well, some people with asthma need to use one inhaler only for relief. Other asthmatics need 3 inhalers, prednisone, singular and theophyline for relief.
Why can't some people just need 250 mg of depakote, while other need 2000 mg of depakote? It make sense to me. If 250 mg reliefs your symptoms ... that is your dose .... no need to go higher for the sake of fitting into some "blood level" chart.
Spike
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