![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by zefdie on October 18, 2005, at 17:10:50
My doctor's been treating me with Zoloft for a very severe depression, but I have terrible racing thoughts of worthlessness and self-doubt and my mind never shuts up. The doctor thinks this is a mixed episode and that I'm Bipolar II. What are your experiences with Depakote? I'm afraid it will make me even more listless and depressed. I'm waiting on starting it.
I've had what were probably hypomanic episodes in the past but they always feel to me like what everyone else must feel on a "normal," steady, nondepressed course: confidence, creativity, excitement, no thoughts of worthlessness or lack of talent. I do tend to think my ideas are awesome and can't get to all of them fast enough, but it's never really increased my productivity. And it's never led to sleeplessness or any problematic behaviors except overspending.
Anyway, I'm just wary of Depakote and thought I would see what y'all think of it. Thanks!
Posted by blueberry on October 18, 2005, at 18:23:00
In reply to Just diagnosed, doc wants me on Depakote. Help!, posted by zefdie on October 18, 2005, at 17:10:50
My situation was very similar to yours...the good kind of hypomania in the past...but developed into a very distressing kind, racing mind, unable to sit still, feeling like I was going 1000mph, anxiety, depression, all mixed together at the same time. Mixed mania my doc called it. Her first choice was depakote, and I was just as wary as you are, but I gave it a shot.
500mg of depakote extended release. Talk about fast. I felt the mania ease off and the depression improve on the first day. In clinical trials, it usually works within 6 days. I've been on it for 3 weeks.
Two side effects for me...increased appetite, which was good...and actually a blah kind of mild depression that begins about 2 hours after dosing and lasts about 6 hours...I guess that's why it is usually taken at bedtime. Very mild headache at first.
I wouldn't be afraid of it. The cool thing is that if it isn't helping in a week or two, your trial with it is done. No long trial needed. Most people at 500mg have no side effects. More common doses are 1000mg to 1500mg, but 500mg is fine for me. Go with the extended release version because it is milder in terms of side effects. It is smoother.
Posted by zefdie on October 18, 2005, at 18:29:27
In reply to Re: Just diagnosed, doc wants me on Depakote. Help!, posted by blueberry on October 18, 2005, at 18:23:00
Thank you! I appreciate your input. What concerns me is that I'm severely depressed and my thoughts, while racing, are ugly, self-defeating, depressive thoughts of worthlessness and hopelessness. I'm just not sure if an anti-convulsant which can deepen depression is right for me. I'm also afraid it will make me even less creative, and right now a writer's block is one of the worst and most frustrating elements of my depression. My mind is fast but it's not allowing me to create.
> My situation was very similar to yours...the good kind of hypomania in the past...but developed into a very distressing kind, racing mind, unable to sit still, feeling like I was going 1000mph, anxiety, depression, all mixed together at the same time. Mixed mania my doc called it. Her first choice was depakote, and I was just as wary as you are, but I gave it a shot.
>
> 500mg of depakote extended release. Talk about fast. I felt the mania ease off and the depression improve on the first day. In clinical trials, it usually works within 6 days. I've been on it for 3 weeks.
>
> Two side effects for me...increased appetite, which was good...and actually a blah kind of mild depression that begins about 2 hours after dosing and lasts about 6 hours...I guess that's why it is usually taken at bedtime. Very mild headache at first.
>
> I wouldn't be afraid of it. The cool thing is that if it isn't helping in a week or two, your trial with it is done. No long trial needed. Most people at 500mg have no side effects. More common doses are 1000mg to 1500mg, but 500mg is fine for me. Go with the extended release version because it is milder in terms of side effects. It is smoother.
Posted by blueberry on October 18, 2005, at 18:51:01
In reply to Re: Just diagnosed, doc wants me on Depakote. Help, posted by zefdie on October 18, 2005, at 18:29:27
Just give it a week and see how it goes. Any other options you might face are going to take longer. Depakote is FAST.
I mentioned that it gives me a mild blah depression for about 6 hours after dosing...but that is actually rather rare from what I've studied on it. The other 18 hours of the day are good.
Posted by med_empowered on October 20, 2005, at 16:08:27
In reply to Re: Just diagnosed, doc wants me on Depakote. Help, posted by blueberry on October 18, 2005, at 18:51:01
hey! Im kind of wary of depakote, too...i do writing in my spare-time, too and I found that mood-stabilizers in general can slow things down; with trileptal, this was more pronounced as the dose go higher (900mgs--bad; 1200mgs--slow thinkin, slow talking zombie)..with Depakote, it seemed so strong that it wasn't so much a matter of what dose made me flatten out as it was HOW flattened out each dose made me. Plus, it made me vomit like crazy. I understand where you're doc's coming from, with your problems being considered a "mixed-episode"...I've had some really bad mixed-episodes, a few with psychotic features...its rough. **BUT** the really important thing with DX'ing a true "mental illness" and not simply "mental discomfort/distress" is **functional impairment**--if your thoughts sometimes race and you feel more productive, but you don't lose control of your behavior and do things that could prove destructive--promiscuous sex, suicide attempts, marriages, spending sprees, overseas travel-- then you may be able to find non-chemical ways of dealing with your problems..that's what I've been doing, with pretty good success (I'm not dissing drugs here, or recommending a drug-free treatment plan; I'm just sharing my experiences). There are also much, much milder drugs to try first..a little bit of Klonopin, either taken daily or taken at the first sign of (hypo)mania (or perhaps just unpleasant hypomania/mixed-episodes) can really go along way to help you regain some equilibrium...its also good for helping with behavioral control, so it makes it less likely you'll do stupid, dangerous things (if thats ever been a problem...) Plus, although the low-grade depression is sometimes referred to as a "rare side effect," I've found that it happens A LOT, at least with me and the people I know. Trileptal at doses sufficient to control my occasional agitation/mixed-episodes was also strong enough to flatten my personality and creativity...it also impaired my academic performance, which is a definite no-no in my book. Now, if these problems bother **YOU** enough that you think you need some chemical assistance in controlling them, you should do it....my advice then would be to focus on keeping the dose as low as possible;for me, it seems to be better to go for "symptom-reduction" and improvement in quality of life than to aim for "symptom control" and reaching an "effective" dose. Also...if you're taking an antidepressant, that can sometimes make things worse, although SSRIs and Effexor are better than the tricyclics in that regard. Minimizing your antidepressant dose and the duration of treatment with an AD can help, as can adding in something like Klonopin to keep low-level agitation from getting out of hand...as-needed antipsychotics help some people (I'd advise using them very, very rarely), and as-needed sleep aids can also be of tremendous help in helping you keep an even keel. Good luck!
Posted by Sebastian on October 22, 2005, at 17:38:34
In reply to Just diagnosed, doc wants me on Depakote. Help!, posted by zefdie on October 18, 2005, at 17:10:50
Take a small dose. I *think* a small dose can be 125 mg. I used to take a large dose, 500 mg x 3 a day. All it did was make me sleepy. It did help for a while. I don't take it any more though. My aunt takes a small dose and seems fine.
Posted by SLS on October 22, 2005, at 22:44:03
In reply to Re: Just diagnosed, doc wants me on Depakote. Help!, posted by blueberry on October 18, 2005, at 18:23:00
> My situation was very similar to yours...the good kind of hypomania in the past...but developed into a very distressing kind, racing mind, unable to sit still, feeling like I was going 1000mph, anxiety, depression, all mixed together at the same time. Mixed mania my doc called it. Her first choice was depakote, and I was just as wary as you are, but I gave it a shot.
>
> 500mg of depakote extended release. Talk about fast. I felt the mania ease off and the depression improve on the first day.This has also been my experience with Depakote. It can put the manic fire out within 48 hours if the dose is high enough. For acute episodes of mania, Depakote can be administered using a "loading dose". A loading dose is a high initial dose that serves to bring the blood levels up to a therapeutic level as quickly as posssible. For some drugs, this dose loading is possible because it is generally well tolerated. For me, 1000mg to 1500mg as an initial dose does the job nicely. The loading dose is often higher than the maintenance therapeuic dose is.
> In clinical trials, it usually works within 6 days.
Hmm. I didn't know that.
> I've been on it for 3 weeks.
I hope it continues to treat you well.
For me, when already depressed, Depakote flattens my affect (although not as bad as lithium) and makes me feel moderately more depressed.
I agree that you shouldn't be afraid of the drug. You are only to give it a brief trial to see if it is the right drug for you. It is a much more effective drug for mixed-states than is lithium, particularly in bipolar II. It is well established.
Not everyone will experience the same side effects. I never gained an ounce of weight on it. Others do not experience the flattening of mood that I get with it.
If you don't like it, you can move on to the next drug. However, it is important that you give Depakote an adequate trial such that your blood is tested to be sure that the levels of Depakote are within the therapeutic range.
It is a good idea to get blood tests for liver function several times over the first 6 months of Depakote usage. Please discuss this with your doctor.
Good luck.
- Scott
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.