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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Roslynn on November 12, 2022, at 13:45:34
Hi all,
Has anyone here with unipolar depression found Depakote to be helpful for depression or anxiety?
I've just been prescribed Depakote as an adjunct along with my other meds and wondered if it's helped anyone else who has depression without any mania.
Any positive stories?
Thank you,
Roslynn
Posted by linkadge on November 12, 2022, at 13:54:45
In reply to Depakote for unipolar depression?, posted by Roslynn on November 12, 2022, at 13:45:34
It certainly can be useful for anxiety. There are studies looking into it for panic disorder and generalized anxiety. There are some studies showing it can be useful as an adjunct to antidepressants for unipolar disorder. I don't think there is much data on its use in unipolar depression (as monotherapy). It's certainly worth a try, especially if there is any anxiety or possibility of bipolar.
I took it previously. It did seem to work with citalopram, but on it's own it left me a bit blah.
Linkadge
Posted by Roslynn on November 12, 2022, at 17:05:00
In reply to Re: Depakote for unipolar depression?, posted by linkadge on November 12, 2022, at 13:54:45
Thank you for weighing in!
Roslynn
Posted by SLS on November 14, 2022, at 7:56:54
In reply to Depakote for unipolar depression?, posted by Roslynn on November 12, 2022, at 13:45:34
Rosalyn,
I agree with linkadge.
Depakote (valproate) is of great value in resolving and preventing mania in bipolar disorder. I really can't comment on whether or not Depakote is of any value in unipolar depression, although as Linkadge mentioned, it does have a calming effect for some people, seemingly in the absence of bipolar disorder.If there are any first degree relatives who have inequivocal bipolar disorder, I would begin using treatments known to work in bipolar depression. It is possible that you have the same bipolar genes as other members of family do. "Depression" emerges not as a single-gene trait. Multiple genes are involved. Two bipolar genes and seven major depression genes might yield a disorder that looks and acts like unipolar depression. I don't know how available or expensive genotyping is, but it is not terribly relevant when making clinical decisions. Family history might be more revealing in the long run.
If there are indeed first degree relatives with bipolar disorder, it won't hurt to experiment with treatments known to be particularly effective when treating bipolar depression.
I am particularly partial to LOW-dosage lithium treatment - 300-450 mg/day, but only for depression in the absence of mania. Didn't your doctor reject the idea of using lithium because of kidney concerns? This is easily resolved by:
1. Taking no more than 450 mg/day of lithium. With lithium, kidney damage is dosage-dependent. I can't guarantee that 300 mg/day will prevent additional damage, but I think it likely that it would. If you have sufficient reason to avoid lithium at all costs, then move on. However, if no one can find incidents of 300 mg/day of lithium causing kidney damage, then I would think seriously about trying low-dosage lithium - but for no more than two weeks. My guess is that if you are responsive to lithium, you will feel better within a week. So, if you can't find evidence that low dosages of lithium have been shown to be nephrotoxic, go for it. Remember, for the experiment, you will be on low-dosage lithium for no more that two weeks to see if it works.
2. Take kidney tests before treatment, and then several times during treatment. Simple.
VERY low dosages of lithium seems to prevent Alzheimer's. That was my reason for continuing to take lithium at 300 mg/day when I could not conclude that it was helping my depression. After a decade of my lithium usage of lithium to prevent Alzheimer's, I discovered that my remission was dependent on it. When I tried to discontinue lithium, I relapsed in a big way. Now *that* is dumb luck.
I should try being dumb more often.
- Scott
Posted by SLS on November 14, 2022, at 8:03:43
In reply to Depakote for unipolar depression?, posted by Roslynn on November 12, 2022, at 13:45:34
Hi, Rosalyn.
There is a critical error in a sentence that I wrote in my previous post.
I wrote: " I can't guarantee that 300 mg/day will prevent additional damage, but I think it likely that it would. If you have sufficient reason to avoid lithium at all costs, then move on."
It should be: "I can't guarantee that 300 mg/day will prevent additional damage, but I think it likely that it _WILL NOT_. If you have sufficient reason to avoid lithium at all costs, then move on."
Sorry.
- Scott
Posted by SLS on November 14, 2022, at 8:49:08
In reply to Crap. This is an important correction » Roslynn, posted by SLS on November 14, 2022, at 8:03:43
This is embarrassing.
Let me try again.
My guess is that 300 mg/day of lithium won't cause kidney damage.
Simple is better.
- Scott
Posted by SLS on November 14, 2022, at 9:48:12
In reply to Crap AGAIN. I forgot my coffee this morning. » SLS, posted by SLS on November 14, 2022, at 8:49:08
> This is embarrassing.
>
> Let me try again.
>
> My guess is that 300 mg/day of lithium won't cause kidney damage.
>
> Simple is better.
>
>
> - Scott
1. "Low dosage lithium augmentation in venlafaxine resistant depression: an open-label study"
https://pubmed.ncbi.nlm.nih.gov/22796912/
2. "Low dosage lithium augmentation in venlafaxine resistant depression: an open-label study "
https://pubmed.ncbi.nlm.nih.gov/22796912/
3. "Long-term, low-dose lithium treatment does not impair renal function in the elderly: a 2-year randomized, placebo-controlled trial followed by single-blind extension"
https://pubmed.ncbi.nlm.nih.gov/25093483/
4. "Association between lithium use and the incidence of dementia and its subtypes: A retrospective cohort study"
https://pubmed.ncbi.nlm.nih.gov/35298477/
5. "Risk of dementia in bipolar disorder and the interplay of lithium: a systematic review and meta-analyses"
https://pubmed.ncbi.nlm.nih.gov/31954065/
--------------------------------------------------------Rosalyn - I think trying low dosage lithium is close to being a no-brainer. Just monitor kidney function before starting lithium, and then at regular intervals afterwards. Remember, this experiment will last no longer than two weeks if there is no response.
* Taking your entire dosage of lithium at night is less harmful to the kidneys than divided doses.
- Scott
Posted by Roslynn on November 14, 2022, at 14:28:35
In reply to Back to the properties of low-dosage lithium: » SLS, posted by SLS on November 14, 2022, at 9:48:12
Dear Scott,
Thank you so much for your help. Unfortunately, I continued to have poor kidney function numbers even at the low dose of 150mg of lithium so my doctor took me off it altogether.
I'm not sure why my kidneys reacted like this but they are slowly recovering.
Maybe Depakote will help me some; I have a parent with bipolar I.
Thank you for all the information and I'm glad you are still doing well.
Best,
Roslynn
Posted by SLS on November 14, 2022, at 21:07:04
In reply to Re: Back to the properties of low-dosage lithium: » SLS, posted by Roslynn on November 14, 2022, at 14:28:35
> Dear Scott,
>
> Thank you so much for your help. Unfortunately, I continued to have poor kidney function numbers even at the low dose of 150mg of lithium so my doctor took me off it altogether.
>
> I'm not sure why my kidneys reacted like this but they are slowly recovering.
>
> Maybe Depakote will help me some; I have a parent with bipolar I.
>
> Thank you for all the information and I'm glad you are still doing well.
>
> Best,
> RoslynnI'm always thinking on your behalf. I am *very* glad to hear that your kidneys are recovering.
I forgot - What was the story with lamotrigine (Lamictal)? For (bipolar) depression, most people find 200 mg/day to be ideal. However, lamotrigine is not an all-or-nothing agent. I had a partial response to 200 mg/day that was stable. However, 300 mg/day was a home run.
I am very sad at this moment. I remember my life before remission. I remember the altered state of consciousness that depression was for me. All mental illnesses are altered states of consciousness. Being drunk is an altered state of consciousness.
Depression was a hideous thing to wake up to every morning and to go to bed with every night.
I have survivor's guilt.
- Scott
Posted by Roslynn on November 15, 2022, at 16:54:35
In reply to Re: Back to the properties of low-dosage lithium: » Roslynn, posted by SLS on November 14, 2022, at 21:07:04
Hi Scott,
Lamictal made me very tired and gave me cognitive difficulties even at the lowest dose.
Thank you for all your input. Don't feel guilty about getting better--you are actually providing a lot of hope for the rest of us.
Best,
Roslynn
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