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Depakote / valproate / valproic acid for insomnia and irritability?

Wish4TheNight

Wish4TheNight

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Hi everyone!
So I'm bipolar 2 and recently came off lithium. The initial plan was for me to start on lamotrigine but because the tapering caused depression and insomnia, I was put on quetiapine (300 mg) instead to help with sleep, which helps a little. I am still mildly depressed, but that's OK, I had that on lithium as well. I now sleep a few hours instead of hardly any, so that's improved too. But it's still not good. I also experience irritability and anger that I didn't have on lithium.

I feel I'm in a mixed sort of state with restlessness, irritability, anger and insomnia, paired with mild depression. It's horrible.

So now my pdoc advised Depakote.
Are there people on here who use it? Does it help with sleep and irritability/anger?
More specifically, is anyone on quetiapine AND Depakote, and how does that combo work for you? Do you have side effects?

Thanks so much.
 
Wishbone

Wishbone

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I'm on Depakote. It's apparently more for mixed states and/or Mania side of things rather than depression but I do get on okay with it. I was on Lithium before and that deadened me too much; I felt like a carboard cutout of myself. At least with Depakote I can feel things. It does help with sleep. Irritability is still a factor to an extent but again less so than before and I've not been through a big spell of it since I've been on it, so I'd say yeah, it improves that too. I've only ever been on Quetiapine without either of the mood stablisers mentioned, and at a lower dose (100mg) which apparently, the consensus seems to be, is more likely to make you sleepy than higher doses. It knocked me right out in that regard! I was so tired on it I couldn't get beyond the 100mg.
However, I do have another antipsychotic that I can use as PRN if I do have a bad spell with irritability, which is Risperidone, and this is okay for me too, takes the edge off. (I haven't needed that for a while now actually, come to think of it. I don't know if that's a plus for Depakote or just coincidental timing).
It's difficult to know what's right changing about like that but I guess we've all done it until we found what worked. I just hear you about that mixed state kind of thing: it's the worst of all when that really gets it's claws into you. Hope you get it sorted soon.
 
Wish4TheNight

Wish4TheNight

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Hi, thank you for your reply.
Good to hear you're positive about Depakote. That definitely helps in making a decision. I'm still going to wait a while, I've only been off lithium for a few days now, hopefully things will improve on its own a bit. If not, Depakote will be the next step.
Thanks again!
 
Wishbone

Wishbone

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No, not really. My weight has remained exactly the same throughout. There's only one side effect which involves certain aspects of the male body, (not the one you're probably thinking of though!) I can't think of anything else.
I would say, however, that long-term you may be better off with Lamotrigine if your main symptoms are the depressive end of the scale. I would assume the mixed affect is only temporary as the medication switch slowly gets sorted out inside of you, but if you do continue with that angsty feeling then Depakote may be alright. But then, if Quetiapine remains as well you're in waters I know nothing about. A little trial and error really.
 
Wishbone

Wishbone

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Oh, and Valproate is not recommended for women who could become pregnant as it can harm the unborn child. I don't know if you're male or female but that's obviously a big one if you're a woman hoping to have kids.
 
Wish4TheNight

Wish4TheNight

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Thank you. Yes, I read about that. I'm female, but I don't want children.
 
K

keith74

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Hi everyone!
So I'm bipolar 2 and recently came off lithium. The initial plan was for me to start on lamotrigine but because the tapering caused depression and insomnia, I was put on quetiapine (300 mg) instead to help with sleep, which helps a little. I am still mildly depressed, but that's OK, I had that on lithium as well. I now sleep a few hours instead of hardly any, so that's improved too. But it's still not good. I also experience irritability and anger that I didn't have on lithium.

I feel I'm in a mixed sort of state with restlessness, irritability, anger and insomnia, paired with mild depression. It's horrible.

So now my pdoc advised Depakote.
Are there people on here who use it? Does it help with sleep and irritability/anger?
More specifically, is anyone on quetiapine AND Depakote, and how does that combo work for you? Do you have side effects?

Thanks so much.
My wife is currently on depakote 1000mg and quetiapine 300mg. She is currently in a depression (hence the quetiapine). She is still struggling with her sleep. The depakote is mostly to guard against mania. She never felt drowsy because of it. In the past, quetiapine was the one that made her sleepy. This was at lower doses when she took it for anxiety and sleep. It doesn't seem to be helping much right now for sleep however.
 
Wish4TheNight

Wish4TheNight

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Hi Keith, thank you for your reply.
So you don't think the Depakote does anything for your wife's sleep?
I have the same experience with quetiapine. When I first started it, it could put me to sleep for about 6-7 hours. But not anymore.
I've read that Depakote works on gaba receptors, hence it would theoretically help with sleep.
I still haven't decided yet about taking it.
How does your wife get her sleep? I take a benzo every few days.
 
K

keith74

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My wife has been on depakote/epival for the better part of 2 decades. She said she never felt much side effects from it. If it has any sleepy effect on her, it is pretty minimal. She has been on doses ranging from 500-1000mg. Of course everyone's side effects are different. When she started taking quetiapine IR, it used to make her feel drowsy pretty quickly and she can sleep 8 hours solid. It was only in her current depressive episode where the drowsy side effect seems to be minimal. The issue with my wife is more staying asleep than falling asleep however. I have heard that quetiapine at higher doses actually has a less sedative effect so maybe that is part of the cause? She started taking gabapentin to help with her anxiety and sleep but currently her dose is low so hard to say if it is helping much. The one thing that does help is clonazepam, which she will also take every few days to avoid getting a dependency on it. But even the clonazepam only gives her few extra hours instead of knocking her out.
 
Wish4TheNight

Wish4TheNight

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Thanks again, Keith.
Sounds like your wife is having a tough time as well. I hope the gabapentin will help her.
 
K

keith74

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Thanks. I think the gabapentin may be helping a little bit with the anxiety. But her sleep is still pretty erratic. I'm thinking of suggesting she see a sleep therapist. I think we just need to be patient and wait for the depression to lift more. Her mood is definitely getting better but just waiting for the sleep to catch up. Hope you sleep improves too.
 
Wishbone

Wishbone

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I do think Depakote has a kind of regulatory effect on sleep. I too have always had problems with it. I either go through phases where I'm sleeping too little or too much, or I wake frequently in the night, never feeling like I've actually slept. Since the Depakote sleep has improved on what it was. I was taking my dose AM and PM, with the slightly higher dose in the morning. I've since switched it to the higher dose in the evening, about two hours before I hope to go to bed, and I sleep much better this way for sure.

Keith, your wife could always ask for a slightly higher dose of Depakote rather than adding too many other things? 1000mg isn't all that much (depending on her size etc, of course).
 
Wish4TheNight

Wish4TheNight

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Thanks. I think the gabapentin may be helping a little bit with the anxiety. But her sleep is still pretty erratic. I'm thinking of suggesting she see a sleep therapist. I think we just need to be patient and wait for the depression to lift more. Her mood is definitely getting better but just waiting for the sleep to catch up. Hope you sleep improves too.
I'm sorry she's still struggling with her sleep and anxiety. Good to hear her mood is improving though. My experience with that is that the sleep will eventually catch up.
All the best.
 
Wish4TheNight

Wish4TheNight

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I do think Depakote has a kind of regulatory effect on sleep. I too have always had problems with it. I either go through phases where I'm sleeping too little or too much, or I wake frequently in the night, never feeling like I've actually slept. Since the Depakote sleep has improved on what it was. I was taking my dose AM and PM, with the slightly higher dose in the morning. I've since switched it to the higher dose in the evening, about two hours before I hope to go to bed, and I sleep much better this way for sure.

Keith, your wife could always ask for a slightly higher dose of Depakote rather than adding too many other things? 1000mg isn't all that much (depending on her size etc, of course).
My sleep pattern sounds a lot like yours. Good to hear Depakote helps with that.
 

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