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DD started Depakote 1000 mgs and has been on it for the past 6 days.  The first two days were 500's then she went to 2 500 at night.  Today DD got up for school and seemed fine and then came to the office to work.  She told me she started to feel sad and anxious and this quickly went to nonstop crying.  An overwhelming feeling of sadness.  At lunch time I took her home and she called me at around 2:30 and was still hysterical crying .  She asked me to call her professor at school  because she had a class at 4pm that she was upset about missing because the professor told them if they miss class their grade goes down.  I have never called a professor before but I did and left a message asking her to call me.  Guess I will explain and what will be will e. 

Anyway I was wondering if anyone had ever had experience with Depakote. I am waiting for P to call me back.

Griz

I have no experience with depakote, but I agree with crazymeds.com (which only officially covers axis 1 disorders, but I think their dosage info is generally good) that unless you are dealing with a crisis response drug you start low and increase slowly and only as needed.  Sometimes a pdoc will try to increase quickly because they think another drug needs to be added also, and adding more than one at a time makes it hard to see what is working and what is not. The side effect profile for depakote is kind of harsh.  There are other options, most likely, if these side effects are too great, although often absent truly extreme reactions patients are advised to try to stick it out for a month or two.

Thanks nomoreoptions:  I looked on the website and wow this drug seems like a horror. I am going to give it a few more days and if things don't improve it will be time to call the P again.  Maybe it is just my imagination but I really feel like the drugs makes DD's depression worse every time.  Well not such a good night.  DD in her room lying in bed watching a movie and has no desire to communicate with me at all.

I may just give in to this as I am so tired today and may just go to bed.  DH on his computer as usual so he probably won't even notice.

Griz

my dd on it for a few months but changed to a different med because P didn't like depakote... .  I did not see any improvements on this drug and while she was on it it was a pretty wild time and getting her off and onto the new meds was also a wild ride... .  I think that dose is a bit high to start with... .  and the side effect of that drug is pretty harsh you are right... .  how frightening for your dd and you... .  I dream of a day when our kids won't need any meds

Depakote is a mood stabilizer, not an antidepressant. Often, if bipolar is suspected or dx, a mood stabilizer is started prior to anti-depressant to avoid getting bumped into manic state by anti-depressant. For me, this bump took on increase in suicidal thinking because I had so much more energy to make plans. I took depakote with seroquel for several years - gained a ton of weight and it had bad effect on my blood pressure. (I was in my 40's at this time and had been battling bipolar II meds for 10 years).

I had to taper slowly off depakote, be off for 3 weeks totally, then I started lamictal. And that has worked the best for me. The seroquel helped a lot with my anger and raging - but I developed an allergy to it after 10 years. So now I am just on the lamictal - it required a very very slow start - 25mg at a time until I got to 300mg.

You D started on a really big dose, really fast. I am very sensitive to psych meds and take it very slowly. It is such an individaul thing with meds. The pdoc really needs to let you in on his whole med plan. I would take her off of it more slower than she went on it. Then start something else if things do not get better.

qcr  

Griz,

I agree with our dear qcr!  Also, I know other kids who have been on depekote, and gained a lot of weight.  I think that the Pdoc clearly knows your dd's issues with weight and could have given her a different med. I feel for her and you.  There are options.   And the dose she is on, and the little amount of time the doc gave her to be a such a strong dose, no wonder your dear girl is having an awful time.   My dd is on another stabalizer, and we amped up very slowly and she did OK.  I am not saying my dd is doing well with her BPD, but she did OK with being put on a mood med slowly.   It seems that many of our pwBPD react to meds, and require a slow intro to them.  Give her a month or two to be up to the full dose... .    Don't know if that is an option now.  How awful for her and all of you, to have dd in this state.  It is overwhelming.  Knowing that in time she will either be ok with med, or eased off and then feel better,  does not help right now.  Will keep you in my thoughts today.

mik

Hi Griz,

A coworker just put his elderly MIL suffering from non alzheimer's related dementia on Depakote and he says it is amazing to see the difference in her clarity and energy. It was like turning on a light bulb, like her past year of hospitalizations, paranoia, dementia just gone in an instant. She is like 90 years old though... .  

I have one son (SS10) on Lamicatal 25mg 2x a day and they are now adding in Abilify because he is becoming psychotic. Lamictal has not caused him any issues but it is not touching his newly dx emerging psychosis so that is why they are adding in Abilify.

My other (SS15) is on Abilify for a year since he became depressed and psychotic.

Both are Dx Bipolar.

I read somewhere that subclinical doses of mood stabilizers are more effective with dealing with BPD. It sounds like your DD is not on a subclinical dose.

Unfortunately I can not find where I read it as I tend to scan the internet and don't always remember where I find these things... so sorry I don't have a source.

Not sure if this helps but I would definitely go to your Pdoc with your concerns today.

   Let us know how it's going.

sorry for my ignorance but what is a subclinical dose.

Griz

My sister, who is a high-functioning pwBPD takes Luvox, an SSRI, very low dosage as she is highly sensitive.  She cuts the 25 mg in three and that small amount works to keep the mood swings in reasonable control.  Even taking 25 mg was too much for her, weight gain and she was becoming rather zombied.

Joel Paris, expert on BPD,  says that SSRIs can sometimes be very effective. 

Griz, does the P think your daughter has bipolar and BPD or just bipolar?   I forget what you had told us before?

Reality

Well... .  of course I read about the subclinical dose right here on bpdfamily.com. Just found it,

Subclinical just means lower than usual dose. Maybe I am using the term wrong but that is the gist of it.


Also- it was the atypical antipsychotics not the Antiepileptics, sorry for the confusion

See

https://bpdfamily.com/message_board/index.php?topic=141634.0

Second article down:

Medications Studied and Used in the Treatment of Borderline Disorder+

Robert O. Fiedel, MD

www.BPDdemystified.com/index.asp?id=21#2


Neuroleptics and Atypical Antipsychotic Agents

The group of medications that has been studied most often for the treatment of patients with borderline disorder are antipsychotic agents (neuroleptics and atypical antipsychotics). Neuroleptics were the first generation of medications used to treat very serious mental illnesses, especially bipolar disorder and schizophrenia. The atypical antipsychotics are the second generation of medications developed to treat these disorders. When prescribed in lower doses than ususal, these agents have been found to be quite useful in the treatment of many patients with borderline disorder. In my clinical experience, this is the most effective class of medications for the disorder, and the most rational starting point for pharmacotherapy.

+++++++++++++++++

Finally, I just asked my coworker who is also a caretaker for his MIL and he said the dose was fairly low of Depakote  (125mg 2 x  a day he thought not looking at the bottle) and she was also on Zyprexa. Ugh, hope this is helping and not making things worse.

MammaMichelle - Interesting about your co-worker MIL.  My mother has some dementia.  We believe that it was radiation induced.  She had radiation to her brain stem.  I am leery to try anything being that she is 88.  But, I am fascinated by what you said about co-worker.  My mother is depressed, but understandably so.  At her age, so many of her firends died, or homebound.  All of her siblings died.  She buried a husband and two sons. And, she has severe osteoarthritis and legally blind.

My dd was increased on Seroquel. Her dr. went from 50 mg twice a day to 100 mg.  She increased the ose after only one week.  My dd was snowed.  She cut back to only 100 mg at nighttime.   She is concerned about weight gain.  She has gained weight.  She has been on house arrest and eats all day.

The P thinks her axis I is bipolar with axis II being BPD.  My older daughter told me that her bf has been on Depakote for 7 years for seizures.  I asked him about it and he said he has had no side effects at all but routinely goes for blood work to check his liver.  DD is going for blood work tomorrow so I will be interested in what that shows.  I asked her today and she doesn't feel any difference taking the Depakote other than having extremely vivid and scary dreams (which I did read was a side effect).

I am monitoring this very carefully and we will go back to the P in two weeks for him to reevalute.  We will be starting DBT group in two weeks so that is good.  It is our second time around although DD feels she is more ready for it now.  I am very hopeful that she is finally ready to participate in getting better.

Griz

I am sorry I forgot about that but my dd also had many dreams on depakote... .  one really bad nightmare that had her shaking in my room one night.

My dd complained of weird dreams, too.  She told me that she had nightmares when she was in jail.  That is when she first started on Seroquel.

 

A lot of the weight gain when I was on depakote was water retention - why my blood pressure was so high. And when I went off I lost 20 pounds in about 3 weeks. I had gained 50 pounds in the four years I was on depakote.