Psycho-Babble Medication Thread 16772

Shown: posts 1 to 18 of 18. This is the beginning of the thread.

 

Depakote makes depression worse ?

Posted by Scott L. Schofield on December 12, 1999, at 14:47:34

I seem to get more depressed when I take more than 1000 mg/day of Depakote.

Has anyone experienced anything like this? If so, did a lower dosage provide the effect you were looking for? Did raising the dosage higher cause the worsened depression to disappear?

Thanks in advance.


- Scott

 

Re: Depakote makes depression worse ?

Posted by S. Suggs on December 12, 1999, at 16:04:28

In reply to Depakote makes depression worse ?, posted by Scott L. Schofield on December 12, 1999, at 14:47:34

How did it make the depression worse, what were the increase in symptoms or new symptoms?

Blessings,

S. Suggs

 

Re: Depakote makes depression worse ?

Posted by Scott L. Schofield on December 12, 1999, at 16:26:40

In reply to Re: Depakote makes depression worse ?, posted by S. Suggs on December 12, 1999, at 16:04:28

> How did it make the depression worse, what were the increase in symptoms or new symptoms?

I suffer from bipolar depression that presents very much like atypical unipolar depression. Depakote 1000+ mg/day causes my depression to worsen as if I were untreated. It does not start a "new" type of depression that feels different from the original. I have experienced this once before.

I get some slight relief from taking Lamictal 300 mg/day. This improvement disappears when I added Depakote 1500 mg/day. I want to try to add Depakote again because I seemed to improve transiently while titrating up quickly to 1500 mg and upon discontinuation. Although the improvement that occurred on the way down may have been a sort of rebound, I can't rule out that lower dosages may work.

Specifically, the addition of Depakote caused a worsening of anergia, psychomotor retardation, memory difficulties, inability to read more than a few sentences at a time, anhedonia, and hypersomnia.

Of course, I would hope that this phenomenon has occurred with others, and that they experienced a therapeutic window within which Depakote works great.

I'm afraid to hope.


Blessings to you...

- Scott

 

Re: Depakote makes depression worse ?

Posted by S. Suggs on December 12, 1999, at 19:44:06

In reply to Re: Depakote makes depression worse ?, posted by Scott L. Schofield on December 12, 1999, at 16:26:40

Scott: I've never taken depakote, however, it does not sound like you have had it at the higher level for that long of a time. If you can, give your body a chance to adjust and see what happens. How about your doc, how does he feel about this approach? God Bless!

S. Suggs

 

Re: Depakote makes depression worse ?

Posted by Elizabeth on December 12, 1999, at 23:27:16

In reply to Depakote makes depression worse ?, posted by Scott L. Schofield on December 12, 1999, at 14:47:34

> I seem to get more depressed when I take more than 1000 mg/day of Depakote.
>
> Has anyone experienced anything like this? If so, did a lower dosage provide the effect you were looking for? Did raising the dosage higher cause the worsened depression to disappear?

Scott,

I didn't experience this myself when I tried Depakote, but I have certainly heard of it happening to others. Can I ask if you've had a serum level since increasing the dose, and what was your level when you were taking 1000mg?

 

Re: Depakote makes depression worse ?

Posted by jamie on December 13, 1999, at 2:09:18

In reply to Depakote makes depression worse ?, posted by Scott L. Schofield on December 12, 1999, at 14:47:34

> I seem to get more depressed when I take more than 1000 mg/day of Depakote.
>

According to The Pill Book and the Physician's Desk Reference, Depakote's most frequent side effects are: nausea, sedation, weakness, skin rash, EMOTIONAL UPSET, DEPRESSION, PSYCHOSIS...side effects increase in intensity and number as your Valproic Acid dose increases.

I think it's weird how drugs that are supposed to help can hurt instead. It's weird how one man's magic is nother man's hell. We all react so different. But your side effects are far from unusual. They are listed right there in the 'frequent' column. You would be wise to stay far away from that drug. Especially when such friendlier and safer drugs are available. Like lamictal, neurontin, or both together. The toilet's a good place for your depakote. jamie

 

Re: Depakote makes depression worse ?

Posted by Zeke on December 13, 1999, at 5:19:27

In reply to Re: Depakote makes depression worse ?, posted by jamie on December 13, 1999, at 2:09:18

Have you tried lithium or Tegretol? (In fact, tegretol shares the basic structure of tricyclic antidepressants.)

Re the reported side effects in the PDR, don't take these TOO literally. For example, if you look up standard antidepressants you might also find depression listed. For one thing, consider the population the drug was testd in initially, Also consider that after approval, that physician only report the adverse reactions to the FDA. Also, the term depression means different things to different people or in different settings; an antidepressant drug may make one feel sleepy, spacey, etc. which can be coined 'depressed' but meanwhile also relieve 'clinical depression.' (Also note that seizures is listed as a side effect of Depakote and other anticonvulsants -- why would neurologists use these meds for epilepsy if that untoward effect were so prevalent.)

I don't mean to discount what's being said however. And Depakote and most of the other meds mentioned were first marketed (and many still only indicated officially) for seizure disorders, and may have negative effects on mood. I mean that wasn't the major concern when they were being tested/approved. Further, their action on neurotransmitter systems may theoretically also produce a depressed affect, ie, by dampening norepinephrine.

I am reminded of the rationale some use in attacking/discounting Prozac.

I don't know that lamictal or neurontin are particularily 'safer' or 'friendlier' than Depakote, even psych wise. But they are different, and may different effects (affects) in different folks as you say. Flushing your Depakote should happen only after conferring with your doctor. And remember that abruptly stopping any anticonvulsant med can precipitate (a) seizure(s) -- they have to be tapered off!

This is stretching the point a bit but consider the connection between psychiatric disorders and epilepsy. Some persons with epilepsy (especially effecting the temporal lobes) experience worsening of the psych problems when their seizures are (better) controlled. In these people the anticonvulsant levels (eg, Depakote) are lowered and seizure controlled lessened to provide psychiatric improvements. This is in line with the effectiveness of ECT, which produces an antidepressant effect from the production of a seizure (despite what antipsychiatry people say). (I don't mean to imply that anti seizure meds therefore blocking a beneficial psych response in general.) In fact, a century ago epilepsy was considered a psychiatric disorder because the treatemnt was so poor and recurrent seizures produced interictal behavioral syndromes (most often schizophrenia-like but also otherwise) that has been termed the 'epileptic personality.' This still occurs in some people without obvious seizures (subclinical epilepsy). There is material about this written elsewhere here at Dr. Bob's site. You may also look t material written by Dietrich Blummer, a psychiatrist who specializes in the epilepsy/psychiatry subject.

Again, after giving the Depakote a good trial -- if it is bearable -- consider other meds mentioned but but also Tegretol (among the anticonvulsants). Or lithium.

 

Re: Depakote makes depression worse ?

Posted by Kev on December 13, 1999, at 9:27:40

In reply to Depakote makes depression worse ?, posted by Scott L. Schofield on December 12, 1999, at 14:47:34

I didn't even know they prescribed it in doses that high. I take 500mg. a day, and the most spectacular effect for me seems to be that it does nothing whatsoever, but the brain-doctor insists I keep taking it. According to this guy, Depakote is supposed to have a mild ANTI-depressant effect, and of course is commonly used to augment anti-depressants.

Regards,

-Kev

 

Re: Depakote makes depression worse ?

Posted by Elizabeth on December 13, 1999, at 12:43:01

In reply to Re: Depakote makes depression worse ?, posted by Kev on December 13, 1999, at 9:27:40

> I didn't even know they prescribed it in doses that high. I take 500mg. a day, and the most spectacular effect for me seems to be that it does nothing whatsoever, but the brain-doctor insists I keep taking it.

I had that happen when I tried Depakote too (both the "no effect" part and the "doctor insists I give it more of a chance" part).

The relevant parameter for Depakote is not the dose but the serum level, which varies widely from person to person on the same dose. Do you happen to know where yours falls? It might depend on your body size, metabolism, liver functioning, other meds, etc.

> According to this guy, Depakote is supposed to have a mild ANTI-depressant effect, and of course is commonly used to augment anti-depressants.

Yeah, it can do that, but in other people it can exacerbate depression. Paradoxical eh?

 

Re: Depakote makes depression worse ?

Posted by Sean on December 13, 1999, at 15:29:53

In reply to Depakote makes depression worse ?, posted by Scott L. Schofield on December 12, 1999, at 14:47:34

> I seem to get more depressed when I take more than 1000 mg/day of Depakote.
>
> Has anyone experienced anything like this? If so, did a lower dosage provide the effect you were looking for? Did raising the dosage higher cause the worsened depression to disappear?
>
> Thanks in advance.
>
>
> - Scott

I noticed that my depression worsened the first
few weeks of using Neurontin. I stuck with it
however, and have stable moods for the first time
in a long time.

 

Re: Depakote makes depression worse ?

Posted by Noa on December 17, 1999, at 2:06:23

In reply to Re: Depakote makes depression worse ?, posted by Sean on December 13, 1999, at 15:29:53

My nephew, now 22, has epilepsy. At 14, he suddenly became extremely depressed. He stopped eating, refused to get out of bed and go to school, and was suicidal. They consulted several doctors and were about to hospitalize him when a new doctor suggested it might be the depakote, which he had only been taking for a short time, after dylantin stopped working. Sure enough, he switched to tegretol, and the depression lifted.

 

Re: Depakote makes depression worse ?

Posted by Scott L. Schofield on December 18, 1999, at 12:29:56

In reply to Re: Depakote makes depression worse ?, posted by Noa on December 17, 1999, at 2:06:23

I would like to thank everyone for their input. It is nice to know that what I am experiencing with Depakote is not some weird idiosyncratic reaction that has never happened to anyone else. I sometimes feel as if it were *my* fault that I'm not responding to drugs the way I'm *supposed* to. I find Noa's post particularly compelling.

I think I'll take the advice to continue with the Depakote a little while longer. It would haunt me if I were to discontinue it without giving it a fair shot.

Thanks again. Your posts helped a lot.


Sincerely,
Scott

 

Depakote anecdote -- Noa

Posted by Zeke on December 20, 1999, at 13:43:54

In reply to Re: Depakote makes depression worse ?, posted by Noa on December 17, 1999, at 2:06:23

>Sure enough, he switched to tegretol, and the depression lifted.

Noa, I think there's more to consider...

1. Tegretol has antidepressant effects.

2. People with epilepsy -- especially with temporal lobe (limbic) foci -- are much more prone to depression. Further, as seizures become controlled, depression etc. often becomes worse, and vice versa...

You could be right but the lifting of the depression could have been due to the Tegretol, rather than the absence of the Depakote. If Depakote did influence the depression, remember that he had epilepsy and the seizure control could set off the depression.

I think this story speaks more strongly of Tegretol. So Scott, consider that as an alternative if things don't improve...

 

Re: Depakote anecdote -- Noa

Posted by Noa on December 21, 1999, at 15:48:06

In reply to Depakote anecdote -- Noa, posted by Zeke on December 20, 1999, at 13:43:54

Interesting.

As it turns out, a couple of years later, he stopped taking the tegretol when he read about the potential harmful effects. I remember him, at around 17 or so, telling me it was hard to think of "death" as a side effect. After that, I don't know if he tried a new med. I think he started some nutritional/alternative health strategies, and also started to see some abatement of siezures as he got older. I guess I'll have to check in with him on this.

 

Re: Depakote anecdote -- Noa

Posted by Scott L. Schofield on December 23, 1999, at 20:00:33

In reply to Depakote anecdote -- Noa, posted by Zeke on December 20, 1999, at 13:43:54

> >Sure enough, he switched to tegretol, and the depression lifted.
>
> Noa, I think there's more to consider...
>
> 1. Tegretol has antidepressant effects.
>
> 2. People with epilepsy -- especially with temporal lobe (limbic) foci -- are much more prone to depression. Further, as seizures become controlled, depression etc. often becomes worse, and vice versa...
>
> You could be right but the lifting of the depression could have been due to the Tegretol, rather than the absence of the Depakote. If Depakote did influence the depression, remember that he had epilepsy and the seizure control could set off the depression.
>
> I think this story speaks more strongly of Tegretol. So Scott, consider that as an alternative if things don't improve...
>
>


Thanks.

For now, I plan to stick with the Depakote for a while longer. I am titrating up more slowly this time, hoping to minimize any idiosyncratic transient effects. My doctor has set 1500 mg/day as the first target. I want to see just how much of an improvement can be squeezed out of it before attempting to add another antidepressant. I found it interesting that my doctor said that the therapeutic range for efficacy in bipolar disorder is actually higher than that of epilepsy. I know that the drug reps are telling psychiatrists to push the dosage beyond 2000 mg/day.

I don't recall ever giving Tegretol an extended trial. I'll definitely keep it in mind.

Has anyone tried a combination of lamotrigine and topiramate?

Thanks again.


- Scott

 

Noa -- 'Death as a side effect'

Posted by Zeke on December 25, 1999, at 22:33:24

In reply to Re: Depakote anecdote -- Noa, posted by Noa on December 21, 1999, at 15:48:06


> I remember him, at around 17 or so, telling me it was hard to think of "death" as a side effect. After that, I don't know if he tried a new med. I think he started some nutritional/alternative health strategies, and also started to see some abatement of siezures as he got older.


Noa --

I actually had epilepsy that went away in my latter teen years. This is referred to by some neurologists as 'benign rolandic epilepsy.'

I agree that death as a side effect is disturbing. And Tegretol in overdose can be fatal as can many other meds mentioned on this board. It can also cause aplastic anemia which can be fatal. Yet, uncontrolled epilepsy is more likely disabling and potentially fatal than Tegretol, eg, status epilecticus -- a rapid flurry of seizures. As to nutritional/alternative health protocols for epilepsy, this should be discouraged as an alternative to medication (or other accepted therapies such as surgery). The only efficacious nutritional approach (for some) is the ketogenic diet, which is absolute removal of all carbohydrates from the diet. Even this needs to be overseen by a physician. I just want to say that folks with epilepsy shouldn't stop taking their meds in favor of alternative health approaches because this is dangerous and potentially fatal.

Again, if death as a side effect is an issue, then look at the side effects of lithium, tricyclic antidepressants, neuroleptics, monoamine oxidase inhibitators, other anticonvulsants, and even OTC meds like Tylenol. And don't forget the 'natural' alternatives either -- St. Johns Wort taken with some other meds (eg, antidepressants) can cause serotonin syndrome which certainly includes death as a side effect.

Sorry, I didn't mean to go off like this but I think folks shouldn't get overly paranoid from what they read in the PDR, especially if they suffer from a serious condition like epilepsy. I'm glad to hear that your cousin was apparantly able to outgrow his seizure disorder though.

Hope you had a Merry Christmas!

 

Re: Depakote anecdote -- Noa

Posted by Ellen on January 30, 2000, at 5:54:52

In reply to Re: Depakote anecdote -- Noa, posted by Scott L. Schofield on December 23, 1999, at 20:00:33

> > Noa, I am taking 15000mg of Depakote and have experienced alot of nausea from it. Do you have this side effect. I have beem at this dose for three weeks and I am getting extremly frustrated feeling like shit all the time. What are you physical side effects. Ellen

 

Re: Depakote anecdote -- Noa

Posted by Noa on January 30, 2000, at 8:05:05

In reply to Re: Depakote anecdote -- Noa, posted by Ellen on January 30, 2000, at 5:54:52

Sorry, Ellen, it wasn't I who is on Depakote. My story was about my nephew, who at 14 became depressed, and then the depression was attributed to the depakote.

I take lithium.


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