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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by theo on February 14, 2005, at 9:41:59
I was wondering if Depakote can be used mono for both depression and anxiety?
Posted by Ritch on February 14, 2005, at 10:21:53
In reply to Does Depakote help with Depression or just Mania?, posted by theo on February 14, 2005, at 9:41:59
> I was wondering if Depakote can be used mono for both depression and anxiety?
There are probably some folks taking just Depakote and it works reasonably well for them for both anxiety and depression... but I haven't seen any people post here about that yet (that I can recall). Just wondering... are you still taking Keppra? If so, how is it helping you? Just curious.
Posted by SLS on February 14, 2005, at 10:31:07
In reply to Does Depakote help with Depression or just Mania?, posted by theo on February 14, 2005, at 9:41:59
> I was wondering if Depakote can be used mono for both depression and anxiety?
I think it would be unusual for Depakote to exert a robust antidepressant effect when treating unipolar depression. It could, however, have an anxiolytic effect of sorts. Although I have never heard of its use in panic disorder, it might be interersting to do some snooping around to see if it has.
Some people with bipolar depression do indeed experience an antidepressant effect from Depakote. This is probably the exception rather than the rule, though. For people who are not manic, Depakote can sometimes make depression feel mildly worse. In bipolar disorder, from mania comes depression*. If you can prevent the manias, you very often prevent the depressions as well. Depakote can do this and is thus a mood stabilizer.
* Generally, the cycle of bipolar disorder is:
normal -> mania -> depression -> normal -> mania -> etc...
Although unusual, some people experience a different pattern:
normal -> depression -> mania -> normal -> depression -> etc...
The latter pattern is much harder to treat it seems.
- Scott
Posted by Ritch on February 14, 2005, at 13:25:48
In reply to Re: Does Depakote help with Depression or just Mania?, posted by SLS on February 14, 2005, at 10:31:07
> Although unusual, some people experience a different pattern:
>
> normal -> depression -> mania -> normal -> depression -> etc...
>
> The latter pattern is much harder to treat it seems.
>
>
> - ScottThat's my general pattern. I tend to "fade" into depression and then "snap out" of depression suddenly into hypomania. If there is dysphoria or hostility there isn't any real "normal" in there it then goes something like this:
Sudden euphoric mania > hostility (or quick switches between dysphoria and euphoria) > depression > quick snap to euphoric mania, etc.
Posted by ST on February 14, 2005, at 15:38:04
In reply to Does Depakote help with Depression or just Mania?, posted by theo on February 14, 2005, at 9:41:59
Hi,
I took Depakote for ten years for BP II (mostly just had depression, though) and it did nothing for the depression. I remember being confused as to why I was just on a mood stabilizer with "downer" type efects when I was so depressed. Eventually my pdoc added Wellbutrin and then also various SSRI's along the way that did the trick. I asked my most recent pdoc if Depakote had any anti-depressive qualities and basically he said no...> I was wondering if Depakote can be used mono for both depression and anxiety?
Posted by Nixon on February 14, 2005, at 17:50:35
In reply to Re: Does Depakote help with Depression or just Mania?, posted by SLS on February 14, 2005, at 10:31:07
> > I was wondering if Depakote can be used mono for both depression and anxiety?
>
> I think it would be unusual for Depakote to exert a robust antidepressant effect when treating unipolar depression. It could, however, have an anxiolytic effect of sorts. Although I have never heard of its use in panic disorder, it might be interersting to do some snooping around to see if it has.
>
> Some people with bipolar depression do indeed experience an antidepressant effect from Depakote. This is probably the exception rather than the rule, though. For people who are not manic, Depakote can sometimes make depression feel mildly worse. In bipolar disorder, from mania comes depression*. If you can prevent the manias, you very often prevent the depressions as well. Depakote can do this and is thus a mood stabilizer.
>
> * Generally, the cycle of bipolar disorder is:
>
> normal -> mania -> depression -> normal -> mania -> etc...
>
> Although unusual, some people experience a different pattern:
>
> normal -> depression -> mania -> normal -> depression -> etc...
>
> The latter pattern is much harder to treat it seems.
>
>
> - ScottHi Scott
Well said and I agree. JN
Posted by theo on February 14, 2005, at 23:33:27
In reply to Re: Does Depakote help with Depression or just Mania? » theo, posted by Ritch on February 14, 2005, at 10:21:53
Currently I'm not taking Keppra only because my doc started me on Lamictal after I was on Keppra for some time.
While on both I started having red eyes, sore throats, etc. so I stopped the Keppra to get a true read on Lamictal by itself. I understand my docs theory of the Keppra for anxiety and the Lamictal for depression, but to much of these anticonvulsants make me feel sick and flu like, run down in general.
I'm staying on Lamictal until my next appointment at the end of this month.
Keppra worked fantastic for me because it helped anxiety yet made me more assertive. Also helped with OCD. I do think I started to get depressed from the Keppra when I was taking it by itself, same reaction I have after taking benzo's a while without an antidepressant.
I'm tempted to try a stimulant just to see how I react since ADD symptoms can easily be compared to a lot of BPII symptoms, at least the ones I'm experiencing. If my doc doesn't let me try a stimulant, I may try Depakote and if that doesn't work, try the Keppra again with Prozac instead of Lamictal.
Ain't this fun!!
Posted by theo on February 14, 2005, at 23:38:37
In reply to Re: Does Depakote help with Depression or just Mania?, posted by SLS on February 14, 2005, at 10:31:07
Do you think ADD can be confused with BPII? My pdoc and I were discussing this and alot of my symptoms seem to fall into both.
I guess the best way to find out would be to simply try a stimulant?
Posted by Ritch on February 15, 2005, at 0:04:04
In reply to Re: Does Depakote help with Depression or just Mania? » Ritch, posted by theo on February 14, 2005, at 23:33:27
> Currently I'm not taking Keppra only because my doc started me on Lamictal after I was on Keppra for some time.
>
> While on both I started having red eyes, sore throats, etc. so I stopped the Keppra to get a true read on Lamictal by itself. I understand my docs theory of the Keppra for anxiety and the Lamictal for depression, but to much of these anticonvulsants make me feel sick and flu like, run down in general.
>
> I'm staying on Lamictal until my next appointment at the end of this month.
>
> Keppra worked fantastic for me because it helped anxiety yet made me more assertive. Also helped with OCD. I do think I started to get depressed from the Keppra when I was taking it by itself, same reaction I have after taking benzo's a while without an antidepressant.
>
> I'm tempted to try a stimulant just to see how I react since ADD symptoms can easily be compared to a lot of BPII symptoms, at least the ones I'm experiencing. If my doc doesn't let me try a stimulant, I may try Depakote and if that doesn't work, try the Keppra again with Prozac instead of Lamictal.
>
> Ain't this fun!!
>
>Oh yeah, Barrel o'fun!
I also got sore throat from Keppra (in the mornings after I got up). It always cleared, figured it was just reflux, who knows?
"but to much of these anticonvulsants make me feel sick and flu like, run down in general"
YES, I also get a flu-like response from combos of AC's. I had a flu-like and barf-like response from a recent trial of Trileptal 75mg at night just for sleep.
I'm thinking about *swapping* Depakote for Keppra and just continuing a little clonazepam with it and *maybe* no antidepressants. Reason: Keppra also helped with some anx. symptoms (better than Depakote) similar to how you describe and didn't make me stupid. Also Keppra is much more "liver friendly". I've got to start thinking about "body burden" issues with these meds. Also, I noticed on Keppra that I didn't need to take as *much* clonazepam, and most importantly.. I got enough sleep. Also, I would like to get a "true read" of taking the Keppra as an antimanic rather than Depakote and then go from there with depression treatment. When I was on Keppra (two different times), I *never* experienced any hypomania induction. I felt some occasional *irratability*, but it wasn't the fuse-blowing kind.
Posted by theo on February 15, 2005, at 7:57:09
In reply to Re: Does Depakote help with Depression or just Mania? » theo, posted by Ritch on February 15, 2005, at 0:04:04
So Depakote is hard on your liver? Did it give you cognitive difficulties, make you sloth like in general? How much did or are you taking and are you taking it once or twice daily, regular or ER version?
I forgot to mention one thing about Keppra, I had to take it 3 times daily instead of just 2. The half life is 6-8 hours and I don't understand why the PI sheet doesn't suggest this. It even says it clears fast and doesn't really "build up", it's in and out. Keppra doesn't seem to smooth out to be able take twice daily, at least for me. What about you, how much and when do you take it?
Posted by Ritch on February 15, 2005, at 9:49:40
In reply to Re: Does Depakote help with Depression or just Mania? » Ritch, posted by theo on February 15, 2005, at 7:57:09
> So Depakote is hard on your liver? Did it give you cognitive difficulties, make you sloth like in general? How much did or are you taking and are you taking it once or twice daily, regular or ER version?
I'm taking 250mg ER at bedtime, and then occasionally an extra 125mg of sprinkle midday. I don't get cog difficulties on Depakote as badly as with lithium or Trileptal and certaintly not as bad as Gabitril or Topamax. Depakote has been around a long time so all the bad stuff that's ever happened is all fairly well documented and there is a black box warning about rare possibility of hepatic failure and potentially fatal pancreatitis. The chances for the liver thing tend to decrease with age and it (Depakote) is generally riskier to use in younger rather than older people. Lithium, OTOH, tends to get more troublesome in older age groups (because therapeutic doses are close to toxic doses). I get liver function tests every so often and thus far have come up ok, so I'm not real worried. Depakote does produce some asthenia (muscle weakness), but then so does Keppra.. Did you notice the "rag doll" feeling on it? In my case it wasn't accompanied by any internal restlessness, that's why I think it may be an acceptable alternative antimanic for me.
>
> I forgot to mention one thing about Keppra, I had to take it 3 times daily instead of just 2. The half life is 6-8 hours and I don't understand why the PI sheet doesn't suggest this. It even says it clears fast and doesn't really "build up", it's in and out. Keppra doesn't seem to smooth out to be able take twice daily, at least for me. What about you, how much and when do you take it?Yes, I did notice a mild "rebound" effect in the middle of the next day.. I went as high as 750mg/day. 500mg at bedtime + 250mg midday. Anyhow, I found that 250mg at bedtime was plenty enough for good sleep. 125mg doses during the day seemed to work ok. Probably two 250mg tabs per day (1 tab at bedtime, 1/2 tab twice during the day) probably would be the best dose for me. The trouble is that they price the stuff the same no matter what strength you buy, so you will pay $$$ for the convenience. Splitting unscored halves of tablets in two wind up with a lot of dust.. don't know if you noticed that or not :)
Posted by theo on February 15, 2005, at 14:35:15
In reply to Re: Does Depakote help with Depression or just Mania? » theo, posted by Ritch on February 15, 2005, at 9:49:40
> > So Depakote is hard on your liver? Did it give you cognitive difficulties, make you sloth like in general? How much did or are you taking and are you taking it once or twice daily, regular or ER version?
>
> I'm taking 250mg ER at bedtime, and then occasionally an extra 125mg of sprinkle midday. I don't get cog difficulties on Depakote as badly as with lithium or Trileptal and certaintly not as bad as Gabitril or Topamax. Depakote has been around a long time so all the bad stuff that's ever happened is all fairly well documented and there is a black box warning about rare possibility of hepatic failure and potentially fatal pancreatitis. The chances for the liver thing tend to decrease with age and it (Depakote) is generally riskier to use in younger rather than older people. Lithium, OTOH, tends to get more troublesome in older age groups (because therapeutic doses are close to toxic doses). I get liver function tests every so often and thus far have come up ok, so I'm not real worried. Depakote does produce some asthenia (muscle weakness), but then so does Keppra.. Did you notice the "rag doll" feeling on it? In my case it wasn't accompanied by any internal restlessness, that's why I think it may be an acceptable alternative antimanic for me.
>
>
> >
> > I forgot to mention one thing about Keppra, I had to take it 3 times daily instead of just 2. The half life is 6-8 hours and I don't understand why the PI sheet doesn't suggest this. It even says it clears fast and doesn't really "build up", it's in and out. Keppra doesn't seem to smooth out to be able take twice daily, at least for me. What about you, how much and when do you take it?
>
> Yes, I did notice a mild "rebound" effect in the middle of the next day.. I went as high as 750mg/day. 500mg at bedtime + 250mg midday. Anyhow, I found that 250mg at bedtime was plenty enough for good sleep. 125mg doses during the day seemed to work ok. Probably two 250mg tabs per day (1 tab at bedtime, 1/2 tab twice during the day) probably would be the best dose for me. The trouble is that they price the stuff the same no matter what strength you buy, so you will pay $$$ for the convenience. Splitting unscored halves of tablets in two wind up with a lot of dust.. don't know if you noticed that or not :)So are you going to stop Depakote ER and try Keppra alone for mania?
I know what you mean about the rag doll effect. It seems to lessen, or maybe I just get used to it, over time. What's weird is that it makes me physically weak, and mentally charged. Can you relate?
When you were at 750mg, did you feel like it was to much? I know when I first start Keppra, I'm a little tired and once I hit 750mg I kind of get charged up, maybe even a little aggressive.
Would you say overall that Keppra is better with less side effects than Depakote ER for anxiety? I'm tempted to try it but at the same time don't know if I have it in me to try another med.
Posted by theo on February 15, 2005, at 17:39:03
In reply to Re: Does Depakote help with Depression or just Mania?, posted by theo on February 15, 2005, at 14:35:15
Posted by Ritch on February 16, 2005, at 0:14:13
In reply to Re: Does Depakote help with Depression or just Mania?, posted by theo on February 15, 2005, at 14:35:15
> > > So Depakote is hard on your liver? Did it give you cognitive difficulties, make you sloth like in general? How much did or are you taking and are you taking it once or twice daily, regular or ER version?
> >
> > I'm taking 250mg ER at bedtime, and then occasionally an extra 125mg of sprinkle midday. I don't get cog difficulties on Depakote as badly as with lithium or Trileptal and certaintly not as bad as Gabitril or Topamax. Depakote has been around a long time so all the bad stuff that's ever happened is all fairly well documented and there is a black box warning about rare possibility of hepatic failure and potentially fatal pancreatitis. The chances for the liver thing tend to decrease with age and it (Depakote) is generally riskier to use in younger rather than older people. Lithium, OTOH, tends to get more troublesome in older age groups (because therapeutic doses are close to toxic doses). I get liver function tests every so often and thus far have come up ok, so I'm not real worried. Depakote does produce some asthenia (muscle weakness), but then so does Keppra.. Did you notice the "rag doll" feeling on it? In my case it wasn't accompanied by any internal restlessness, that's why I think it may be an acceptable alternative antimanic for me.
> >
> >
> > >
> > > I forgot to mention one thing about Keppra, I had to take it 3 times daily instead of just 2. The half life is 6-8 hours and I don't understand why the PI sheet doesn't suggest this. It even says it clears fast and doesn't really "build up", it's in and out. Keppra doesn't seem to smooth out to be able take twice daily, at least for me. What about you, how much and when do you take it?
> >
> > Yes, I did notice a mild "rebound" effect in the middle of the next day.. I went as high as 750mg/day. 500mg at bedtime + 250mg midday. Anyhow, I found that 250mg at bedtime was plenty enough for good sleep. 125mg doses during the day seemed to work ok. Probably two 250mg tabs per day (1 tab at bedtime, 1/2 tab twice during the day) probably would be the best dose for me. The trouble is that they price the stuff the same no matter what strength you buy, so you will pay $$$ for the convenience. Splitting unscored halves of tablets in two wind up with a lot of dust.. don't know if you noticed that or not :)
>
> So are you going to stop Depakote ER and try Keppra alone for mania?Not *planning* to stop, but curious to see if it will work just as well or perhaps better. I don't know. Depakote has a generalized energy-reducing ability, BUT in the past year or two it seems to have declining antimanic efficacy and it definitely is *fragmenting* and screwing up my sleep architecture. Oddly enough, I took low-dose Neurontin for a couple of years without an "accepted" antimanic and didn't do really much worse than I'm doing now. Bottom line: If I can get similar or improved antimanic efficacy on a more "liver-friendly" drug that can be taken on a relatively long-term regimen and provide better sleep architecture, then I want to go there.
>
> I know what you mean about the rag doll effect. It seems to lessen, or maybe I just get used to it, over time. What's weird is that it makes me physically weak, and mentally charged. Can you relate?I didn't get *any* cognitive sfx from Keppra. It did seem to clear brain fog if anything. I liked that. Just didn't like the PHYSICAL "lying around", LISTLESS feeling in the daytime. It was like a simultaneous "fearless feeling" AND "not driven to do much of anything either feeling". But, not feeling bummed out that I wasn't doing anything... but not really feeling numbed like on an SSRI.. I guess to sum up, it must be the asthenia I suppose that is the worst about it that I don't like.
>
> When you were at 750mg, did you feel like it was to much? I know when I first start Keppra, I'm a little tired and once I hit 750mg I kind of get charged up, maybe even a little aggressive.I increased to 750mg relatively quickly. All I know is that 125mg at night wasn't enough for sleep, and 250mg worked fine. 250mg doses in the daytime *did* seem a little much. So, that's how I found out that 750mg/day was "a bit much". 500mg day total seemed just about right.
>
> Would you say overall that Keppra is better with less side effects than Depakote ER for anxiety? I'm tempted to try it but at the same time don't know if I have it in me to try another med.
>
>Gabapentin has been the best AC for anxiety that I've ever taken, hands down. Keppra is somewhat close to it in *some* ways. It is tough to compare Depakote to Keppra for *anxiety* because it is is difficult to determine at times just where that anxiety is coming from.
Posted by theo on February 16, 2005, at 14:17:23
In reply to Re: Does Depakote help with Depression or just Mania? » theo, posted by Ritch on February 16, 2005, at 0:14:13
Are you still taking Gabapentin?
Posted by Ritch on February 16, 2005, at 22:29:54
In reply to Re: Does Depakote help with Depression or just Mania? » Ritch, posted by theo on February 16, 2005, at 14:17:23
> Are you still taking Gabapentin?
No, my pdoc doesn't want me to.
It is true that it has induced a mild
non-dysphoric hypomania. So, I'm not
taking it. Just Depakote+clonazepam
plus 1/2 mg of Celexa every other day.
Posted by catmint on February 18, 2005, at 10:23:17
In reply to Re: Does Depakote help with Depression or just Mania? » theo, posted by Ritch on February 16, 2005, at 22:29:54
Hi,
I have been on 250 ER for about a month. I do notice the muscle weakness and because I am athletic, I think I might take it every other day.Twice now, I have been having a strange thing happen to me at work. I will be walking along and all of a sudden it feels like the floor drops under me or like their is mild tremor, or like I'm going to faint. I did also have some nausea while this was happening.
Do you guys think i'ts the Depakote? Have you ever had anything like this? I'm also on Lamictal.
Thanks,
Amy
Posted by Ritch on February 18, 2005, at 21:45:42
In reply to Re: Depakote side-effect is it normal?, posted by catmint on February 18, 2005, at 10:23:17
> Hi,
> I have been on 250 ER for about a month. I do notice the muscle weakness and because I am athletic, I think I might take it every other day.
>
> Twice now, I have been having a strange thing happen to me at work. I will be walking along and all of a sudden it feels like the floor drops under me or like their is mild tremor, or like I'm going to faint. I did also have some nausea while this was happening.
>
> Do you guys think i'ts the Depakote? Have you ever had anything like this? I'm also on Lamictal.
>
> Thanks,
> Amy
Wow, that's hard to say what is causing what. I've never taken Lamictal so I can't propose that it is a smoking gun in that respect. There are for *sure* things musculoskeletal-wise that happen adversely with me and Depakote, however. It causes a *left-side only* hand tremor. It is fairly light, but if I increase dosage it starts becoming visible-if I try to hold my left hand out straight and still. If I try to hold a phone with my left hand against my head, my hand starts to "flutter" and makes it difficult to hold there. Also, my *left leg* gets nerve zaps, where it feels like a cell phone on vibrate mode is going off in a stream from the top of my leg down through my left foot. Annoying, but not debilitating. Also, on the *RIGHT* side I get a generalized "fluttering" in my right eyelid area. I looked it up once and it's called "chorea". Certain OTHER meds taken with Depakote seem to enhance these "tremors" or "flutters". Cymbalta caused an outright eye stye (in the right eye). Celexa (esp. at higher doses) aggravates all of the left-sided ones. A lot of the musculoskeletal things I've experienced over the last few years are probably attributable to Depakote.. mostly interacting with the other meds. If it is a tremor thing... I would guess the Depakote. I also get "twitchies" from it. Sudden flurries of muscle movement (mostly in the legs). Just an FYI, but lithium would give me big twitches in my legs and some cramps (deep tendon reflexes). Just a guess, but I suppose it is sodium channel blockades. Wild speculation there, don't know.
Posted by n@oise on February 19, 2005, at 14:38:50
In reply to Re: Depakote side-effect is it normal?, posted by catmint on February 18, 2005, at 10:23:17
> Hi,
> I have been on 250 ER for about a month. I do notice the muscle weakness and because I am athletic, I think I might take it every other day.
>
> Twice now, I have been having a strange thing happen to me at work. I will be walking along and all of a sudden it feels like the floor drops under me or like their is mild tremor, or like I'm going to faint. I did also have some nausea while this was happening.
>
> Do you guys think i'ts the Depakote? Have you ever had anything like this? I'm also on Lamictal.
>
> Thanks,
> Amy
hey amyi think ive experienced the same....i call it 'the thuds'. they come on sorta quickly, outta the blue. you don't quite feel dizzy but its' a really bizare, unsettling sensation that's nearly indescribable. it kinda feels like your insides are moving, crawling under your skin. almost like a weird electric shocky kinda feeling...yes?
i've been travelling the world, running from my diagnosis for 6 years. not uncommon of many bipolars, i was self medicating. primarily my poison was class A drugs...lots of them. and drink of course. certain withdrawl symptoms from all of the above inspired me to devise the term "the thuds". this is what you may be experiencing, obviously on a much lower scale! it's what i get as well.
i've been on depakote/epival(1250mg) and, the love of my life, lamictal(200mg) (as well as effexor and clonazepam).
now, after all that said, i've only ever experienced the aforementioned thuds when i haven't taken my meds for a couple of days or if i'm a bit off schedule(it happens to the best of us haha). i've heard of others experiencing similar sensations but again, only when you go off meds. about 7 years ago i was on paxil because i was anorexic and bulimic, getting depressed and having panic attacks. i'm a writer and they were numbing me creatively, on top of that they were useless anyway so i took myself off them and subsequently suffered HARDCORE thuds for four months SOLID. #*&$@^% nightmare. and the whole time, never thought it coulda have been the withdrawl...dope.
anyway, sister. that's all the advice/info i can offer. if you're taking meds regularly and not skipping doses then have a chat with your pdoc.
one last bit of advice for you!...this is YOUR process. don't just take meds b/c pdoc says so. if the side effects don't go away tell your pdoc and GET OFF THEM! i'm really only learning the importance of this now. its empowering but i wish i'd said something earlier.
hope my meandering blabathon was of some help!
best of luck :D
naoise
Posted by gromit on February 20, 2005, at 1:15:30
In reply to Re: Depakote side-effect is it normal?, posted by n@oise on February 19, 2005, at 14:38:50
> one last bit of advice for you!...this is YOUR process. don't just take meds b/c pdoc says so. if the side effects don't go away tell your pdoc and GET OFF THEM! i'm really only learning the importance of this now. its empowering but i wish i'd said something earlier.
Amen to that, it's your life and you only get one shot at it. I wish I had realized it a long time ago also...
This is the end of the thread.
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