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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by colin wallace on July 26, 2002, at 11:35:39
I have here near my keyboard ,an innocuous looking pack of epilim chrono.
I am told that it is 'the same thing' as Depakote.I checked on the Depakote brand website, and they state that these two products are not to be confused, ie. epilim is for epilepsy only.
I am highly dubious about popping one of these babies, even more so than before.
Valproate monotherapy for depressive mood crashes? My instinct tells me to throw them away and order some lamictal or else maybe use them at the lowest dose (200mg) for a couple of weeks, till it arrives, and then ditch it.
My psych. deems me fit not to be seen for another 6 months- two days ago, I was so angrily depressed (following zoloft discontinuation) I was maniacally driving at 90mph and playing traffic 'chicken', seriously considering a head-on crash.I think my psych. actually disbelieved me, or was disinterested.
As all the meds have left my system, that memory appalls me, and I feel stable, and quite normal.
My 'mania' is purely antidepressant induced, and was hitherto unknown.I now have to try to stave off the depression that will invariably occur.
But epilim monotherapy??Hmmmmmmm.
Any thoughts most welcome.Col,
Posted by Ritch on July 28, 2002, at 11:01:45
In reply to Epilim Chrono???, posted by colin wallace on July 26, 2002, at 11:35:39
> I have here near my keyboard ,an innocuous looking pack of epilim chrono.
> I am told that it is 'the same thing' as Depakote.I checked on the Depakote brand website, and they state that these two products are not to be confused, ie. epilim is for epilepsy only.
> I am highly dubious about popping one of these babies, even more so than before.
> Valproate monotherapy for depressive mood crashes? My instinct tells me to throw them away and order some lamictal or else maybe use them at the lowest dose (200mg) for a couple of weeks, till it arrives, and then ditch it.
> My psych. deems me fit not to be seen for another 6 months- two days ago, I was so angrily depressed (following zoloft discontinuation) I was maniacally driving at 90mph and playing traffic 'chicken', seriously considering a head-on crash.I think my psych. actually disbelieved me, or was disinterested.
> As all the meds have left my system, that memory appalls me, and I feel stable, and quite normal.
> My 'mania' is purely antidepressant induced, and was hitherto unknown.I now have to try to stave off the depression that will invariably occur.
> But epilim monotherapy??Hmmmmmmm.
> Any thoughts most welcome.
>
> Col,Colin,
Epilim and Depakote are different preparations of valproic acid (VPA). Once the meds get into your bloodstream they are essentially the same. Epilim is sodium valproate, Depakote is divalproex sodium-which is a combination of sodium valproate and valproic acid. So, you would be taking essentially the same thing. I don't know why Abbott says that Epilim is for epilepsy only?? I checked an Australian website about Epilim and it is considered an "anticonvulsant/antipsychotic". Perhaps it is just CYA for Abbott to mention that, or maybe they don't want their "competition" to get any more sales for bipolar disorder than necessary :) Actually valproic acid (VPA) is off patent protection-it has been around since 1974 I think. Several people manufacture different preparations of VPA. Depakote is just a patented *formulation* of VPA with an enteric coating.
OH, about the lamotrigine thing. I wouldn't tinker around with *that* one on your own. Some pdocs here that prescribe it are very familiar with the signs and symptoms of SJS (the life-threatening rash stuff), and often have a dermatologist to refer their patients to (often to determine whether it is LTG related or not-esp. if their patients are doing well on it and they want to continue the drug).
You could try the Epilim on its own for awhile and see how it goes. I can't take VPA on its own. I take AD's, but at very *tiny* doses to keep my head above water, otherwise I will get hypomanic, rages, bad stuff.. I remember when I started Prozac the first time back in 1992. I started right off with a 20mg capsule---had a little nausea, etc., but after about 7 or 8 days on it I was sleeping about 2 hrs a night (and hallucinating) and my pupils were dilated! UGGH. I kept pushing the dose down, down, down, to about 2.5mg a day, and I stayed on that for several years with little problems (with lithium). If the Epilim winds up making your mood too flat, you could try a tiny dose of an AD that has worked for you before, or you could ask for lithium instead of or in addition to the VPA. I just wouldn't want to do the lamotrigine thing by myself..
hope this helps,
Mitch
Posted by colin wallace on July 29, 2002, at 3:32:46
In reply to Re: Epilim Chrono??? » colin wallace , posted by Ritch on July 28, 2002, at 11:01:45
Thanks Mitch,
It's been three days now for me on a mere 200mg of valproate, and it has undoubtedly exerted a calming effect.Side effects thus far are (1)
some incoordination/weakness (2) a feeling something like having an egg-whisk inserted into my brain at high velocity after drinking a little beer with lunch- (3)bizarre, remeron-like dreams that I'm not at all sure I like (woke up this morning after having a philosophical discussion with a segmented, translucent great
white shark, encased in a monolithic ice-block on my back lawn, and quite insistent on being set free- I was dubious!! (analyse that someone ??)
My symptoms (aside from insane dreams) seem to closely mirror yours actually, from what I've read of your posts.Prozac at 20 mg turned me into an enraged whirling dervish, and my psychs. response (upping the dose to 40mg) led to serious preparations for a suicide attempt.
(******* halfwitted b****** of a psych.- won't forgive that one in a hurry).Later placed me on effexor at 150mg!!- imagine that catastrophe.Bit my tooth in half in a blind anger and almost hung myself.And so it goes on, and on....
Funny, without the derangement induced by AD's, I've rarely, if ever, lost my temper in my entire life, even under severe stress.
Anyway, I take on board what you say about the lamictal, although I really couldn't do any worse than I have with professional 'help' so far.
I now call the shots as far as meds are concerned, won't be dictated to by a psych., and will draw my own conclusions as I gauge my own reactions to meds (I stubbornly demanded either lithium, depakote, lamictal, or a low-dose combo. at my last visit to a new psych., discussed the relative merits of each- and dismissed out of hand any suggestion of an AD addition- at any dosage ).God only knows if I can undo the damage wrought by years of highly destabilizing meds. that have greatly worsened my condition.
I will of course, sensibly stick to the depakote and give it a fair trial,but there is no way on earth that my psych. (who wants to see me next year!)will even consider lithium, let alone a combo.Lamactil is out of the question.
And sadly, I tend to get severely depressed as winter nears, and I need some AD prophylaxis.
So I'm on my own (again), and prepared to take some risks if necessary.Thanks for listening.
Col.
Posted by Ritch on July 29, 2002, at 8:45:45
In reply to Re: Epilim Chrono???--Mitch, posted by colin wallace on July 29, 2002, at 3:32:46
> Thanks Mitch,
>
> It's been three days now for me on a mere 200mg of valproate, and it has undoubtedly exerted a calming effect.Side effects thus far are (1)
> some incoordination/weakness (2) a feeling something like having an egg-whisk inserted into my brain at high velocity after drinking a little beer with lunch- (3)bizarre, remeron-like dreams that I'm not at all sure I like (woke up this morning after having a philosophical discussion with a segmented, translucent great
> white shark, encased in a monolithic ice-block on my back lawn, and quite insistent on being set free- I was dubious!! (analyse that someone ??)
> My symptoms (aside from insane dreams) seem to closely mirror yours actually, from what I've read of your posts.Prozac at 20 mg turned me into an enraged whirling dervish, and my psychs. response (upping the dose to 40mg) led to serious preparations for a suicide attempt.
> (******* halfwitted b****** of a psych.- won't forgive that one in a hurry).Later placed me on effexor at 150mg!!- imagine that catastrophe.Bit my tooth in half in a blind anger and almost hung myself.And so it goes on, and on....
> Funny, without the derangement induced by AD's, I've rarely, if ever, lost my temper in my entire life, even under severe stress.
> Anyway, I take on board what you say about the lamictal, although I really couldn't do any worse than I have with professional 'help' so far.
> I now call the shots as far as meds are concerned, won't be dictated to by a psych., and will draw my own conclusions as I gauge my own reactions to meds (I stubbornly demanded either lithium, depakote, lamictal, or a low-dose combo. at my last visit to a new psych., discussed the relative merits of each- and dismissed out of hand any suggestion of an AD addition- at any dosage ).God only knows if I can undo the damage wrought by years of highly destabilizing meds. that have greatly worsened my condition.
> I will of course, sensibly stick to the depakote and give it a fair trial,but there is no way on earth that my psych. (who wants to see me next year!)will even consider lithium, let alone a combo.Lamactil is out of the question.
> And sadly, I tend to get severely depressed as winter nears, and I need some AD prophylaxis.
> So I'm on my own (again), and prepared to take some risks if necessary.
>
> Thanks for listening.
>
> Col.Hey, no problem. I don't live in the UK, but I have heard a lot of squawks about the psychiatrists there. Just be careful if you try the lamotrigine, and make sure to follow the titration schedule conservatively. Post here about any problems you might be having with it-there are a lot of folks that are taking Lamictal that read here. If the ice melts around the shark-watch out! Tell us what happens :)
Mitch
Posted by Ron Hill on July 29, 2002, at 10:48:54
In reply to Epilim Chrono???, posted by colin wallace on July 26, 2002, at 11:35:39
Colin,
As I said earlier, if you happen to be a person that does not develop a rash (SJS or otherwise) on Lamictal, it might turn out to be a very good medication for you. Lamictal can induce mania in some bipolar patients (JohnX2, for example).
The key to taking Lamictal, as I understand it, is to "start low and go slow". In other words, begin at a very low dosage, say 25 mg/day, and ramp it up slowly. Many people who developed a rash by initially jumping up to a full strength dose have found success with Lamictal by discontinuing the medication and starting over using the "low and slow" technique. However, some think that once the rash has presented itself, the patient is much more susceptible to the rash reoccurring even when the follow-up trial is done using the low and slow method. The pdoc I was using at the time started me off at about 200 mg/day. WRONG!!!
If the rash shows up, it is difficult to get rid of. My dermatologist determined that it was not SJS and then prescribed a corticosteroid topical ointment to clear it up. It worked fairly well but the corticosteroid can only be used for about 14 days. And soon I found the rash covering more and more of my body so I took myself off of Lamictal.
Bottom line: As a preventive measure to minimize the chance of developing a rash, go low and go slow. Due some research (on this site and others) regarding the appropriate starting dosage and ramping rate. One disadvantage of Lamictal is that, if the patient is in mania, it takes awhile to bring the blood level up to the applicable therapeutic range. In cases like this, many pdocs will use Depakote to control the mania while ramping up the Lamictal. From there, some get rid of the Depakote and use Lamictal monotherapy while others use a combination of the two.
-- Ron
------------------------------------
> I have here near my keyboard ,an innocuous looking pack of epilim chrono.
> I am told that it is 'the same thing' as Depakote.I checked on the Depakote brand website, and they state that these two products are not to be confused, ie. epilim is for epilepsy only.
> I am highly dubious about popping one of these babies, even more so than before.
> Valproate monotherapy for depressive mood crashes? My instinct tells me to throw them away and order some lamictal or else maybe use them at the lowest dose (200mg) for a couple of weeks, till it arrives, and then ditch it.
> My psych. deems me fit not to be seen for another 6 months- two days ago, I was so angrily depressed (following zoloft discontinuation) I was maniacally driving at 90mph and playing traffic 'chicken', seriously considering a head-on crash.I think my psych. actually disbelieved me, or was disinterested.
> As all the meds have left my system, that memory appalls me, and I feel stable, and quite normal.
> My 'mania' is purely antidepressant induced, and was hitherto unknown.I now have to try to stave off the depression that will invariably occur.
> But epilim monotherapy??Hmmmmmmm.
> Any thoughts most welcome.
>
> Col,
This is the end of the thread.
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