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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Kingfish on August 26, 2001, at 18:40:25
My apologies to those who kindly answered my post before. I gotta archiveda pretty quickly, so I thoughta I'da askeda againa.
Have been on Depakote for about a week - 750mg at night, 250 in the morning. It seems to have overwritten other meds.
Very tired and have some muscle cramps, but is helping my brain think clearly again. I believe the scientific term is "my brain is no longer mushy". It pulled me out of a very bad depression, and I don't know if that even makes sense.
Anyone's personal experience is appreciated.
Thanks!
- K.
Posted by SalArmy4me on August 26, 2001, at 19:07:35
In reply to Depakote personal experience requested..., posted by Kingfish on August 26, 2001, at 18:40:25
Switch to the new Depakote ER formulation to avoid daytime sedation.
Posted by judy1 on August 26, 2001, at 20:23:27
In reply to Depakote personal experience requested..., posted by Kingfish on August 26, 2001, at 18:40:25
I think you may have written the only post I've ever read that credited Depakote for relief of depression. After 4 years and countless medications, it is the only med that works quickly and effectively in ending my manic episodes (usually along with risperdal or zyprexa), but because of it's depressing effects I never take it longer than a week after the episode ends. Have you had a blood level taken yet?- judy
Posted by Kingfish on August 26, 2001, at 20:28:46
In reply to Re: Depakote personal experience requested... » Kingfish, posted by judy1 on August 26, 2001, at 20:23:27
> I haven't had a blood level done yet, so maybe it was just coincidence. I don't know. Within, say two days, I started to think clearly again. Maybe I was having a "mixed episode"? All I know is I was bawling last Monday, and by Wednesday I was able to think things through again.
Manic episodes have been increasing, so pdoc prescribed this for rapid cycling more than anything I think.
Posted by judy1 on August 27, 2001, at 1:37:03
In reply to Re: Depakote personal experience requested... » judy1, posted by Kingfish on August 26, 2001, at 20:28:46
I've used those words, 'clearer thinking' myself after being on depakote for 24 hours. Usually my pdoc does 'oral loading' bringing my blood levels up to 80-100 range. So, maybe you were having a mixed episode- like an agitated depression?- then depakote works really great. I'm glad you're having success and hope it continues- judy
Posted by Ignatz on August 27, 2001, at 8:08:48
In reply to Re: Depakote personal experience requested... » Kingfish, posted by judy1 on August 27, 2001, at 1:37:03
Depakote has been extremely helpful for me several times for agitated depression. Even after the first day of it, I feel better, and after about 3 I'm pretty functional. I've been on 1500 a day since the last time this happened 4 months ago, and am wondering whether I should keep on taking it as a maintenance thing or just take it when I get freaky-- which happened about three times last year, but it was a high-stress year. (I also take Effexor XR 300 a day.) It does make some of my hair fall out, which is annoying.
Posted by Kingfish on August 27, 2001, at 11:55:11
In reply to Re: Depakote personal experience requested..., posted by Ignatz on August 27, 2001, at 8:08:48
Ignatz:
I think you have given me my new alter ego - Krazy Kat it is!!
I keep forgetting to take my vitamin - that should remind me!
It continues to help me, though I may be going up, up, up again because didn't sleep last night and feel fine today. He increased my Prozac last week, too, so must watch that.
Thank you for your input! I am so relieved to be accomplishing a few things a day again.
- K. (See, I could even keep my signature)
Posted by susan C on August 27, 2001, at 16:19:06
In reply to Re: Depakote personal experience requested..., posted by Kingfish on August 27, 2001, at 11:55:11
I don't know, Krazy Kat...mmm but maybe ok two mice to one cat even if all are crazy????
My consult with 'world famous pdoc' said depakote would help even out the highs, because the lows follow the highs.
I am confused about you also taking prozac, any SSRI and what I have read here and else where is caution on combining rapid cycling with prozac...
Is it another one of those many 'opinions' in the medical world?
Glad to hear you are rising out of the fog.
one way or t'other.
your friend MM
Susan C
> Ignatz:
>
> I think you have given me my new alter ego - Krazy Kat it is!!
>
> I keep forgetting to take my vitamin - that should remind me!
>
> It continues to help me, though I may be going up, up, up again because didn't sleep last night and feel fine today. He increased my Prozac last week, too, so must watch that.
>
> Thank you for your input! I am so relieved to be accomplishing a few things a day again.
>
> - K. (See, I could even keep my signature)
Posted by Krazy Kat on August 27, 2001, at 16:35:00
In reply to Re: Depakote personal experience requested..., posted by susan C on August 27, 2001, at 16:19:06
> Thanks for posting again, MM. Krazy Kat would never be a foe for MM - he would just love him to death.
I am watching the Prozac as carefully as I can. My pdoc doesn't seem to know. I didn't sleep much last night, but then I slept all weekend, but I know if I start going up again I have to call him. But that's difficult to do, you know?
Ultimately I'd love to go down/titrate off the Prozac because it has caused cognitive trouble and some paranoia (I think).
Salute to all meeces!
- KK
p.s. have not touched even the drop of the wine, but am forgetting my vitamin some days so may not have any hair when all is said and done...
Posted by Ignatz on August 27, 2001, at 22:11:29
In reply to Re: Depakote personal experience requested..., posted by Krazy Kat on August 27, 2001, at 16:35:00
Always glad to find fellow Herriman fans. Don't know what y'all were saying about wine earlier, but I find that when I'm taking Depakote, I don't want to drink. Which is a good thing, because my p-doc says not to with Dep. When I do, I bypass happy and go straight to headachy.
Posted by Krazy Kat on August 28, 2001, at 13:02:50
In reply to Re: Depakote personal experience requested..., posted by Ignatz on August 27, 2001, at 22:11:29
Well, that's good to know. I have not touched a drop of wine, which I love, because it all seems serious now, who know? I have had alcohol abuse problems, and really have to question if I can keep it moderate. So, if it doesn't help the mood anyway, that's good to know. Although I still love the taste. O well.
I am now Krazy Kat. I got out my old book and am bothering everyone with quotes which make absolutely no sense.
Posted by SalArmy4me on August 28, 2001, at 21:18:08
In reply to Re: Depakote personal experience requested..., posted by Krazy Kat on August 28, 2001, at 13:02:50
Sonne, Susan C. PharmD. Naltrexone for Individuals With Comorbid Bipolar Disorder and Alcohol Dependence. Journal of Clinical Psychopharmacology. 20(1):114-115, February 2000:
"It is well-known that bipolar disorder and substance abuse commonly occur together. However, there is little guidance in the literature concerning the concurrent treatment of these disorders. Naltrexone is a Food and Drug Administration-approved agent for treating alcoholism; however, the studies evaluating its use were done in individuals without psychiatric comorbidity. The following cases describe our experience with naltrexone in two patients with bipolar disorder.
Patient 1
Ms. A, a 30-year-old woman, had a long-standing history of bipolar disorder and alcohol dependence. She also had a history of becoming irritable and aggressive when manic; alcohol intoxication also often led to aggressive behavior, for which she had been arrested. Ms. A had been doing well for approximately 3 months while receiving divalproex 2,000 mg/day and lithium 600 mg/day, but then she started feeling hypomanic with a decreased need for sleep, she communicated with loud, pressured speech, and she reported feeling "jazzed-up." Because she often started drinking when she felt like this, which worsened her behavioral disinhibition, she requested a medication to decrease her desire for alcohol. Her urine drug screen was negative.Ms. A was prescribed naltrexone at 12.5 mg/day for 2 days, increasing to 50 mg/day over the next several days. After the first 12.5-mg dose, Ms. A called to report side effects of nausea, tremor, dysphoria, diaphoresis, and muscle aches. These symptoms dissipated over the next 18 to 24 hours. She refused to take another dose.
Patient 2
Ms. B, a 32-year-old woman, also had a long-standing history of bipolar disorder and alcohol dependence. She had been receiving divalproex 1,500 mg/day for bipolar disorder for approximately 9 months, but she was beginning to feel irritable and reported sleep disturbance, intermittent crying spells, and racing thoughts. She was drinking approximately a bottle of wine per day, which she had not been willing to stop. After much discussion that the alcohol could be contributing to her affective symptoms, she consented to trying naltrexone to decrease her urge to drink.Ms. B was not known to be an opiate abuser, and she denied taking any type of opiate medication. Naltrexone 12.5 mg/day was initiated. She reported side effects after the first dose, including severe nausea with vomiting and piloerection. She refused to take another dose.
Discussion
Naltrexone is generally well tolerated in the alcoholic population, so the severe side effects and medication discontinuation reported by these two women are unusual. There are several possible explanations for the adverse effects they experienced. The symptoms reported by both women are consistent with symptoms of opiate withdrawal. Both women were hypomanic at the time of the first dosing. Mania may be an affective state associated with the production of more endogenous opiates,1 which would make individuals in this state exquisitely sensitive to the actions of an opiate antagonist. There are some data to support that women are more sensitive to the opioid-withdrawal side effects associated with naltrexone.2 It is also possible there is an interaction between divalproex and naltrexone. These two cases suggest that caution should be exercised when prescribing naltrexone to the bipolar individual, particularly during mania or hypomania."-------------------------------------------------
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Posted by Renegade on October 11, 2001, at 11:22:18
In reply to Re: Depakote personal experience requested..., posted by Krazy Kat on August 28, 2001, at 13:02:50
Sorry to bring back old threads. I'm new here and wanted to know if anyone had any experiences with Depakote and other prescribed (or not) drugs, specifically when stopping Depakote but any experiences I'd like to hear. I'm taking it for it's anti-siezure effects, and have many lung related (severe asthma and lung infection) prescriptions. I've been trying to reduce my dosage per the doctors orders but its causing an unusually high amount of withdrawal symptoms. To the point I recognized it was like when I was taken of a morphine prescription. I weaned myself off the morphine a few years ago with doctor's guidance, but with this much milder medicine I'm having to have my roomates help. I keep having to these mood swings that make me angry and want to go find the pills (I gave her the bottle to dispense from early on because I'll never get the dose lowered otherwise). For instance it's about time for another dose and it's taking a tremendous amount of restraint not to bust into her room for the pills. Mood was never a consideration when I was put on this medicine. It was chosen because Dilantin (another anti-siezure med) gave me an allergic reaction instead. I've read about some who have experienced Depakote withdrawal but never to this point. The day dosage is being dropped because the levels interfered with my ability to do much during the day because of the other meds (the night dosage is the same). It's only 250 day 500 night (was 500/500). Any thoughts would be appreciated.
Renegade
>
> I am now Krazy Kat. I got out my old book and am bothering everyone with quotes which make absolutely no sense.
Posted by Mitch on October 11, 2001, at 23:05:22
In reply to Re: Depakote personal experience requested..., posted by Renegade on October 11, 2001, at 11:22:18
> Sorry to bring back old threads. I'm new here and wanted to know if anyone had any experiences with Depakote and other prescribed (or not) drugs, specifically when stopping Depakote but any experiences I'd like to hear. I'm taking it for it's anti-siezure effects, and have many lung related (severe asthma and lung infection) prescriptions. I've been trying to reduce my dosage per the doctors orders but its causing an unusually high amount of withdrawal symptoms. To the point I recognized it was like when I was taken of a morphine prescription. I weaned myself off the morphine a few years ago with doctor's guidance, but with this much milder medicine I'm having to have my roomates help. I keep having to these mood swings that make me angry and want to go find the pills (I gave her the bottle to dispense from early on because I'll never get the dose lowered otherwise). For instance it's about time for another dose and it's taking a tremendous amount of restraint not to bust into her room for the pills. Mood was never a consideration when I was put on this medicine. It was chosen because Dilantin (another anti-siezure med) gave me an allergic reaction instead. I've read about some who have experienced Depakote withdrawal but never to this point. The day dosage is being dropped because the levels interfered with my ability to do much during the day because of the other meds (the night dosage is the same). It's only 250 day 500 night (was 500/500). Any thoughts would be appreciated.
>
> RenegadeHello,
Got a few questions, first. What type of seizures are you needing to control? Are you making a switch (cross-taper) from Depakote to a different AED, which one? I am guessing you are being switched away from Depakote onto another AED, otherwise you would lose seizure control, right? I was switched from Depakote to Gabitril a couple of years ago and I had a decently uncomfortable agitative withdrawal (and was warned by neuro about it), but it subsided after a couple of weeks. I went from 500mg/day to 250mg/day for a week, then stopped it. When I *stopped* it was when the agitation started. The reason I ask the above questions is that the AED you are being switched to (if any) may be the cause of the anger and agitation instead of Depakote withdrawal symptoms.
Mitch
Posted by Renegade on October 12, 2001, at 10:22:19
In reply to Re: Depakote personal experience requested... » Renegade, posted by Mitch on October 11, 2001, at 23:05:22
> Got a few questions, first. What type of seizures are you needing to control?
The neurologist believes they are febril, not epileptic or narcaleptic, and caused because of how severe my asthma is and the condition of my lungs (nearly always infected no matter what I try and they are permanently damaged from so many bouts of pnemonia which I seem to get regularly for no reason though my GI doc says it may be due to lack of nutrients as I have Crohns disease as well, and its being left untreated for the moment in lieu of the siezure and asthma problems).
>Are you making a switch (cross-taper) from Depakote to a different AED, which one? I am guessing you are being switched away from Depakote onto another AED, otherwise you would lose seizure control, right?
No, just reduced from 1000mg a day to 250mg, and its not just agitation, though that is what seems to be most prevalent. They are wide mood swings like I've never experienced as an adult. I was on Desipramine as a child for rage bouts. I actually crave these pills. I cannot focus on much of anything else, and as time goes by it seems to get worse (I know Depakote is time delay and processed by the liver which may explain that.)
>I was switched from Depakote to Gabitril a couple of years ago and I had a decently uncomfortable agitative withdrawal (and was warned by neuro about it), but it subsided after a couple of weeks. I went from 500mg/day to 250mg/day for a week, then stopped it. When I *stopped* it was when the agitation started. The reason I ask the above questions is that the AED you are being switched to (if any) may be the cause of the anger and agitation instead of Depakote withdrawal symptoms.
>
> MitchIt may well be because I'm also on prescriptions that cause excitability and nervousness. Today is day 7. Yesterday was extremely unpleasant to say the least. I've also experienced something since before the medication was lowered akin to passing out. I will suddenly "fall asleep" and when my roomates wake me up (turns out to be more of a trance) I will forget the last few minutes up to an hour. This was one reason for the lowering of the dosage by the doctor as those aren't thought to be siezures by the doctor. That has not stopped. He felt it was too much Depakote for my body causing this. He warned me I'd posibly feel a bit irritated for a few days, but that's it. When I started taking Depakote I was upset at having to take this med (because I may always have to and that I find unpleasant to start with). My first siezure was on Sept 1st (ironically the aniversery of an accident that had me on prescribed morphine for several years). The second was in the hospital and I haven't had one since the people in the hospital put me on Depakote. The reason Depakote may be a lifetime thing is because of my lung history. The siezures were both life threating, caused me to lose breathing and need immediate intensive care. They said several times in the hospital I stopped breathing and my heart stopped but there was nobody to see if it was another siezure. By the time the nurse rushed in, I was fine, but I was also starting the Depakote pills. After about 4 days these things stopped, now they don't want me off the medication. Thank you for your reply.
Renegade
Posted by Mitch on October 12, 2001, at 11:55:25
In reply to Re: Depakote personal experience requested..., posted by Renegade on October 12, 2001, at 10:22:19
> > Got a few questions, first. What type of seizures are you needing to control?
>
> The neurologist believes they are febril, not epileptic or narcaleptic, and caused because of how severe my asthma is and the condition of my lungs (nearly always infected no matter what I try and they are permanently damaged from so many bouts of pnemonia which I seem to get regularly for no reason though my GI doc says it may be due to lack of nutrients as I have Crohns disease as well, and its being left untreated for the moment in lieu of the siezure and asthma problems).
>
> >Are you making a switch (cross-taper) from Depakote to a different AED, which one? I am guessing you are being switched away from Depakote onto another AED, otherwise you would lose seizure control, right?
>
> No, just reduced from 1000mg a day to 250mg, and its not just agitation, though that is what seems to be most prevalent. They are wide mood swings like I've never experienced as an adult. I was on Desipramine as a child for rage bouts. I actually crave these pills. I cannot focus on much of anything else, and as time goes by it seems to get worse (I know Depakote is time delay and processed by the liver which may explain that.)
>
> >I was switched from Depakote to Gabitril a couple of years ago and I had a decently uncomfortable agitative withdrawal (and was warned by neuro about it), but it subsided after a couple of weeks. I went from 500mg/day to 250mg/day for a week, then stopped it. When I *stopped* it was when the agitation started. The reason I ask the above questions is that the AED you are being switched to (if any) may be the cause of the anger and agitation instead of Depakote withdrawal symptoms.
>
> >
> > Mitch
>
> It may well be because I'm also on prescriptions that cause excitability and nervousness. Today is day 7. Yesterday was extremely unpleasant to say the least. I've also experienced something since before the medication was lowered akin to passing out. I will suddenly "fall asleep" and when my roomates wake me up (turns out to be more of a trance) I will forget the last few minutes up to an hour. This was one reason for the lowering of the dosage by the doctor as those aren't thought to be siezures by the doctor. That has not stopped. He felt it was too much Depakote for my body causing this. He warned me I'd posibly feel a bit irritated for a few days, but that's it. When I started taking Depakote I was upset at having to take this med (because I may always have to and that I find unpleasant to start with). My first siezure was on Sept 1st (ironically the aniversery of an accident that had me on prescribed morphine for several years). The second was in the hospital and I haven't had one since the people in the hospital put me on Depakote. The reason Depakote may be a lifetime thing is because of my lung history. The siezures were both life threating, caused me to lose breathing and need immediate intensive care. They said several times in the hospital I stopped breathing and my heart stopped but there was nobody to see if it was another siezure. By the time the nurse rushed in, I was fine, but I was also starting the Depakote pills. After about 4 days these things stopped, now they don't want me off the medication. Thank you for your reply.
>
> RenegadeI think your doctor is on track with reducing the dosage of the Depakote. Your mood swings could be a "rebound" effect of reducing the dosage which might settle down after a couple of weeks. When I stopped Depakote I had a rebound effect too, that lasted a few weeks. OH, another thought I just had: My brother has asthma (developed in his early 50's), and he takes steroids for it. Steroids are also notorious for setting off mood instability and hostility. The mood swings may be primarily induced by any steroids you need to take and the Depakote puts a lid on them. If the moodiness persists you might ask your neurologist if he could add another AED that isn't as sedative as Depakote (i.e. lowdose Neurontin, Trileptal, or Gabitril)to see if that helps.
Mitch
This is the end of the thread.
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