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Depakote / valproate / valproic acid for insomnia and irritability?

Wish4TheNight

Wish4TheNight

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That is a pretty low dose so I image you got started on that dose to ramp you up slowly and observe for any side effects. You'll need to get up to at least 750mg before you really get any benefits. Good luck!
She said it might work at this dose because I'm also on q but that we'll propably need to increase it. Thank you so much for your consistent support through all of this!
 
K

keith74

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She said it might work at this dose because I'm also on q but that we'll propably need to increase it. Thank you so much for your consistent support through all of this!
hmm... that is interesting. They are two different class of meds. I assume she will do a blood test after a week or so to see if the level of depakote is at a therapeutic range. I would expect that she will bump it up to at least 500mg (that was the lowest my wife was ever on when combined with quetiapine). Good luck with everything!
 
Wish4TheNight

Wish4TheNight

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She said we'd evaluate in 4 weeks and never mentioned a blood test...

I googled "low dose valproate" and interestingly found this article:


It concludes that 79% of the tested people with rapid cycling bipolar 2 and dysthymia had a positive response to valproate at doses from 150-500. People with more severe bipolar 2 needed higher doses though. (They didn't include people with bipolar 1 in the study).
Given that my bipolar 2 is pretty mild, I find this encouraging.
 
Wish4TheNight

Wish4TheNight

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Also, on drugs.com I found a "moderate" drug interaction between valproate and Q. It says you can get increased side effects like "dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination."
Maybe my psychiatrist confused increased side effects with increased effect? (Tbh she's not the most knowledgeable psychiatrist one can imagine).
 
Wish4TheNight

Wish4TheNight

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Keith, while reading about valproate I found this, it might be interesting for you and your wife. This article:


And specifically this passage:

"From our case series, it is suggested that the higher doses of valproate, such as those used in the treatment of acute mania, may cause a depressive switch following remission from the manic episode. So consideration should be given to reducing the dose of valproate if a patient develops depressive symptoms following recovery from the manic episode, as a therapeutic strategy. The cases also indicate that relatively lower doses and serum levels of valproate are effective in the maintenance phase compared to those needed in the acute manic phase of bipolar disorder. We acknowledge the limitations of the above hypotheses as these are based on the observations made in the above reported four cases only."
 
Wishbone

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Hope it works for you Wish. I don't believe Depakote needs a blood test for effectiveness because it's not as precarious as Lithium in that respect, and that's the only one I know of that needs monitoring in that way. I certainly never had one anyway it was just a case of reaching a level that felt like it was doing something. I don't remember what I started on but it would have been lowish and increased fairly quickly to get to where I needed to be.
 
Wish4TheNight

Wish4TheNight

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Hope it works for you Wish. I don't believe Depakote needs a blood test for effectiveness because it's not as precarious as Lithium in that respect, and that's the only one I know of that needs monitoring in that way. I certainly never had one anyway it was just a case of reaching a level that felt like it was doing something. I don't remember what I started on but it would have been lowish and increased fairly quickly to get to where I needed to be.
Thanks, Wish ;)
 
K

keith74

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Keith, while reading about valproate I found this, it might be interesting for you and your wife. This article:


And specifically this passage:

"From our case series, it is suggested that the higher doses of valproate, such as those used in the treatment of acute mania, may cause a depressive switch following remission from the manic episode. So consideration should be given to reducing the dose of valproate if a patient develops depressive symptoms following recovery from the manic episode, as a therapeutic strategy. The cases also indicate that relatively lower doses and serum levels of valproate are effective in the maintenance phase compared to those needed in the acute manic phase of bipolar disorder. We acknowledge the limitations of the above hypotheses as these are based on the observations made in the above reported four cases only."
I've never heard that. Very interesting. I have always been aware that antidepressants can trigger mania but never about a mood stabilizer triggering depression.

I should mention that valporate doses specifically for acute mania tend to be pretty high (1500+). My wife has never been that high (currently at 1000mg). Maintenance doses tend to be 750-1500.
 
K

keith74

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She said we'd evaluate in 4 weeks and never mentioned a blood test...

I googled "low dose valproate" and interestingly found this article:


It concludes that 79% of the tested people with rapid cycling bipolar 2 and dysthymia had a positive response to valproate at doses from 150-500. People with more severe bipolar 2 needed higher doses though. (They didn't include people with bipolar 1 in the study).
Given that my bipolar 2 is pretty mild, I find this encouraging.
Also very interesting. Again this is something I never heard of until now. Thanks for sharing.
 
Wish4TheNight

Wish4TheNight

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It's been 6 days since I started Depakote. Yesterday I noticed the inner restlessness was gone. Last night I didn't take a sleeping pill and I slept! It wasn't perfect, it wasn't even good, because I had a lot of nightmares, but I fell asleep within two hours (lately it took me over three hours to fall asleep). I woke up several times but was able to go back to sleep again pretty quickly.
I am so relieved! I'm hoping for continuing improvement but I am optimistic.
 
K

keith74

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It's been 6 days since I started Depakote. Yesterday I noticed the inner restlessness was gone. Last night I didn't take a sleeping pill and I slept! It wasn't perfect, it wasn't even good, because I had a lot of nightmares, but I fell asleep within two hours (lately it took me over three hours to fall asleep). I woke up several times but was able to go back to sleep again pretty quickly.
I am so relieved! I'm hoping for continuing improvement but I am optimistic.
That's great to hear! Wishing you continued improvement!
 
K

keith74

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How is your wife doing these days, Keith?
Thanks for asking! Her mood continues to improve. I'd say her depression is just "mild" now. She's come a long way. But her sleep is still pretty erratic. That seems to be taking a long time to sort out.
 

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