Depakote (Valproic Acid): a Mood Stabilizing Medication frequently used in Bipolar Disorder

Dr. Pagnani of Rittenhouse Psychiatric Associates discusses Depakote (Valproic Acid) and its use in bipolar affective disorder for acute manias and as a maintenance medication (to prevent manias in euthyia). Depakote is used outside of the field of psychiatry for seizure disorders and it is also used for migraine prophylaxis in some individuals as well. With that said, it does have the potential for side effects, and individuals who take this medication should have routine lab-work, specifically monitoring their liver function, blood cell counts and other items.
Dr. Pagnani is the founder and medical director of Rittenhouse Psychiatric Associates, an Instructor at The Johns Hopkins Hospital for the Department of Psychiatry, he supervises psychiatric residents at Jefferson Hospital, he serves on the Young Professional Board of Uplift, the Center for Grieving Children and he maintains a private practice of Psychiatry in Philadelphia where he sees patients for one-time psychiatric evaluations and second opinions. He is a licensed physician and surgeon in NJ, PA, NY, MD, DE, FL and CA and can provide consultations to individuals via HIPAA compliant Telehealth visits living in these locations.
Rittenhouse Psychiatric Associates is a private practice of psychiatry consisting of about 25 psychiatrists, psychiatric nurse practitioners and psychotherapists with physical locations in Philadelphia and Paoli, PA and serving all of PA, NJ, NY and FL virtually via HIPAA compliant tele-psychiatry. Individuals seeking not only evaluations but long-term psychiatric care, can contact Rittenhouse Psychiatric Associates directly.
These videos aim to increase awareness and discussion of mental health topics and to encourage struggling individuals to schedule an appointment directly with a mental health provider. Mental health needs to be normalized, and simply speaking about mental health topics openly, is an important first step.
Dr. Pagnani and Rittenhouse Psychiatric Associates are NOT advocating for or against the use of any mentioned psychiatric medications for any specific individual. Additionally, any side effects mentioned are not a complete list of potential side effects or contraindications to taking any mentioned medications, and all risks and benefits of a medication should be discussed with an individual’s provider at an appointment, before starting, stopping or making changes to a medication regimen.
This video is INFORMATIVE ONLY - NOT MEDICAL ADVICE.
If you are researching a specific topic, please view our KZbin channel, click all videos and use the search function. Please also visit and follow us on instagram and FB: @RittenhousePsych.
www.RittenhousePA.com
www.ChrisPagnaniMD.com

[@billsf94131]

I'm a 65 yr. old male andI've been on depakote for eight years now and love it. It started working for me immediately and completely ended my mania from bipolar 1. I was told to work my way up to 750mg, but I have a very low tolerance to mind drugs and 250mg per day is all I need.

[@RittenhousePsych]

Thank you so much for sharing, and I'm glad that you're doing well! - Dr. Pagnani

[@michaelduvau572]

​@@RittenhousePsychhow much should I take

[@awolf81]

Per the research that’s like a homeopathic dose. That’s great that it works for you.

[@dixiefish0173]

@@RittenhousePsychsame for me been on it for many years

[@SilentHallows]

I was taking this for 2 weeks and it make my anxiety, panic attacks, and MDD heavily worse, which caused me to go into In-patient care. I learned it was killing my liver from the test they did there. I got lucky that i caught it early and didnt die

[@RittenhousePsych]

Thank you for sharing your personal experience. I am sorry to hear that you had so much trouble with this medication. Of note, as you allude to, Depakote can affect someone's liver function, and if a patient is prescribed this medication, it's very important that their provider is monitoring liver function tests. I hope that you are well, and have gotten the care that you need. Sincerely, - Dr. Pagnani

[@kartikaggarwal2625]

What was your dosage?

[@rogerfournier3284]

I started taking Depakote six month ago. Went from 500 mg to 750 mg. Take it at night. It does calm down my mental thought processes, and is good for Bipolar Disorder.

[@Algebrainiac]

Did it make you gain weight

[@rogerfournier3284]

No, I haven’t gained weight thus far, it depends on your metabolism.

[@Algebrainiac]

@@rogerfournier3284what about liver problems?

[@sucrosenight6347]

Thanks for this video.

[@RittenhousePsych]

Thank you for watching!

[@gloriaasafo9666]

Im on depakote for mood disorder .. bipolar &' its good it helps the pain in the head go away .. 🙂

[@RittenhousePsych]

Thank you for sharing and I'm glad that it is working well for you. - Dr. Pagnani

[@jeremybutler1087]

It has helped me greatly!

[@jallisabutler3224]

I’ve been telling my doctor that I’ve had the tremors but didn’t know where it was coming from and it appears to be this medication. Once I stopped using it the tremors went away

[@CashewsClayy]

I used this for a month for off label use with a Dr and my life , mental health, muscles health, spinal cord health is all drastically damaged. What a horrendous medication. Oh and it basically removes all the androgens from y penis and now I have those issues in which I NEVER had those issues and it shrunk. This is what that medication can do to a man. Beard hair fell out too but that is the only part that has slowly gotten better but everything else is like living in a nightmare along with constant panic attacks and suicidal thoughts every minute and I never had a hat either. Absolutely disheartening and disturbing to say the least.

[@warriorl8207]

I have tried a few anti depressants but didnt help. I went to my Dr last week & said its bad i cant fight this anymore. Walking became a routine but when i stop, its a good reason. She put me on Sodium Valporate, I am amazed, i dont want to stay in bed anymore, I interact with people like I use to. I can feel my personality for the 1st time in years. At an inpatient stay years ago I was told i was borderline bi polar. Now that i have found the right medication does this mean I have more bi polar symptoms which is reflected in its the only meds that help me.

[@RittenhousePsych]

Thank you for sharing your personal experiences, and I'm so glad that you have found a medication that has helped you with your symptoms. It's difficult to say whether your improvement is related to a certain diagnosis without a full evaluation. I apologize that I cannot give you a more definitive answer, but this is a great question to discuss directly with your provider. I wish you the best, - Dr. Pagnani

[@GiveHimGlory89]

Odds of aquiring Tardive dyskinesia from long term use?

[@JamesHopton-ek7ct]

Depakote was giving me really bad tremors I just can’t take Depakote at all

[@Algebrainiac]

So I’m gonna be on Depakote 250 mg. I am worried this is gonna cause a lot of weight gain. I hope this doesn’t cause insane appetite like abilify did. Then again I am also going to be on venlafaxine. 37.5 mg. I will see how this goes… if it makes me gain a lot of weight then yeah no…

[@lindseym3511]

Is there any way to minimize the weight gain and hair loss?

[@KarinaAndrade-ey7gn]

Try using cogentin twice a day idk

[@taliaeategg2027]

It's the best mood stabilizer that works for me, lithium worked for a bit but not long term

[@danharris923]

yup im 44 been on it for 5 yrs, 2000mg qd this drug saved my life. long term side effect for me is tremors. my hands shake like I'm an alcholic...lol i like this much more than lithium

[@RittenhousePsych]

Thank you for sharing, and I'm glad to hear that this medication has been helpful for you, and that you are doing well. I am sure that you have, but it's important to discuss any side effects (like tremor) with your provider. There may be ways that they can decrease that side effect (with timing of doses, medications like Beta Blockers etc). However, if the medication is working well, and the side effect is tolerable (and unavoidable), then it's certainly reasonable to continue per your provider. Thank you again, - Dr. Pagnani

[@evacameron8670]

Covered in bruises for my daughter and she looks skinny arms and rib cage

[@bloodmoonvampire6632]

Im female and am in a committed relationship and want a family eventually but we're almost 30 and I'm on birth control. I'm on depakote and I'm worried i can never have a child. i don't know what to do and it breaks my heart.😢

[@RittenhousePsych]

Thank you for sharing this personal information. As you've alluded to, taking Depakote (Valproic Acid) is generally a contraindication to pregnancy, as it increases the risks of neural tube defects. However, it is in my experience, that if a patient is family planning and desiring children, that providers will go out of their way, to try to find a safer medication option (or combination of medications), so that a patient's regimen does not prevent them from having a family. If your provider has been un-open to this, you could always get a second opinion (for example, a full evaluation with report from an academic center's psychiatry department, or just from another psychiatrist who specializes in women's mental health). I will keep you and your partner in my thoughts, and hope that this will be helpful. Sincerely, - Dr. Pagnani

[@HelloNotMe9999]

Why would anyone prescribe this for ADHD? No history of bipolar disorder or seizures. Documented problems with low blood pressure and depression…

[@nyvirrgo]

Not a doctor but I do have ADHD and Bipolar type 2 I was prescribed depakote today for nightly use if you’re taking an adhd stimulant in the am the depakote may be to help you sleep if that’s been an issue -sorry if this comment is unhelpful I’m ima sorta manic state rn haven’t even picked up my depakote yet but I have been medicated since age 5 (26 now)

[@mohamediqbal.p7622]

I take this 250mg and dogmatil 200mg together each 3 days in a week, before it was 500mg and one dogmatil daily, now i reduced dosage myself, age 36

[@anikm111]

Hey Doctor. Thank you for your opinions. My father, diagnosed with bipolar disorder and taking depakote for 10 years. He is currently taking 750mg desval er (valproic acid/depakote). He is retired, 65. He has no problems of mood but he only became very lazy, always stay at home, doesn't go outside often, doesn't want to interact with people or society but he has no depression problem.. Has little tremors on hands, got some weight gain. He never tried lithium. Will it be good to switch to lithium or stay on valproic acid for his long term overall body and mental health.

[@joshbanker8743]

I just got on depakote almost 2 weeks ago. I got on it because I tried lamictal when I was in highschool and it actually really helped alot. A few years later at 21 I got to get back on it but it didn't work for some reason. I ended up having an episode due to a bad situation and shot out some windows and was in jail for 4 months with no prior criminal history. I even took the max dose of lamictal for months in jail. Nothing. I don't know if I was taking it wrong or something. Nevertheless I'm hoping depakote will increase in its effect and help. I heard it works similar to the lamictal and it works with sodium channels but that lamictal lowers the glutamine in the brain whereas depakote increases GABA. Anyway, I deal with racing thoughts. Anxiety depressive and OCD symptoms. I was just wondering if you would be able to help me understand why it wasn't working. In the case that I might get back on it because I have never had any mania.

[@RittenhousePsych]

Thank you so much for sharing your personal experiences, and I am sorry that you've been having difficulty. It's not uncommon for a medication to have one effect when someone is in their teens or early 20's, and then their condition to evolve during their 20's, to respond differently. Typically someone's mood disorder and it's treatment response (in my experience) is mostly solidified by mid-twenties/ early thirties. Lamictal can work too much like an anti-depressant for some (activating, causing mania, or just not preventing mania). For others, it can be very effective. Depakote is often a more effective medication for treating mania. I do not know what your condition is, as I have not evaluated you, but I do hope that this is helpful. Of note, off-label Depakote can also help with anxiety and racing throughts as well, for some. I'd recommend discussing all of this with your provider. Sincerely, - Dr. Pagnani

[@MrMalzers]

In terms of birth defects in being sexually active. Is this for females only or males as well?

[@RittenhousePsych]

Great question! Just for females. Best,

[@michaelduvau572]

​@@RittenhousePsychhow do you know this doc

[@RebekkaRN1962]

​@@michaelduvau572 Just biological females bc biological males cannot get pregnant.

[@Bonnaybolonay]

Is this a good drug to use for borderline personality disorder? I am in weekly therapy however my moods become extreme and intense very quickly. Would 250mg help with that?

[@TOOMUCHSAUCE91]

wont long term use of this medication cause liver failure? Im taking 1500 mg daily ER.. I do feel its beating up my kidneys since my urine is cloudy and my stool is a bit yellow (liver). My doc said no... I want several opinions...

[@RittenhousePsych]

I'm glad that you are discussing your concerns about your kidneys, urine and stool with your provider. It's important that you continue to do so, and second opinions can be very helpful. Without evaluating you and doing labs myself, I cannot know for sure if the depakote is causing difficulties. With that said, I have seen many patients who have taken depakote for decades without significant side effects. What's important is that providers routinely check labs (for depakote, those labs would typically include LFTs (liver function), CBC (blood cell counts) and valproate levels). Providers may need to check other labs based on patient's history and report (like ammonia levels). Thank you for your question and for watching. - Dr. Pagnani

[@stevensicherman4101]

If someone is predominantly depressed, does the mood stabilizer bring a person to normal? Thank you

[@21minute]

I'm not a doctor, but as far as I know, mood stabilizers are for those with a lot of manic episodes or rapid mood cycling. Antidepressants are usually prescribed when someone is predominantly in depressive episode.

[@RittenhousePsych]

Thank you for watching and your question. Typically, mood stabilizers are used for individuals with bipolar disorder. Meaning, they prevent both manias and depressions in this population of individuals. That's called "maintenance" (maintenance of normal mood). They can also be used to bring someone down from a mania, or up from a depression (back to normal mood). With that said, if someone is acutely depressed or manic, there may be many reasons why a provider would choose one medication over another over another (or even use a different class of medications short-term). They can be used in other conditions besides bipolar disorder, or even off label at times as well. It's important to discuss directly with a mental health provider, if someone's concerned about their mood or depression. Best, - Dr. Pagnani

[@denisecox3125]

This medicine balances out the low lows and high highs…it is life altering for me personally. Didn’t realize it until I went without over 2 months and lived in pure Hell. So depressed or so hyped up I was having panic attacks and anxiety all day too. It helps me not take life so seriously or frantically.

[@chanuminimethmabandara8119]

Sir, my mother is taking Sodium valporate for around 8 -10 years and she had 2 episodes of depression (inability to sleep) Does she have to take them life time? Can't we omitt?

[@zaymusic6796]

I went too mental health yesterday they prescribed me this I feel too good only side effects I’m having is I can’t stop rocking back and forth and I’m kinda still tired last night was my first time taking it for my bipolar

[@RittenhousePsych]

Thank you for sharing, and I am glad to hear that you are seeking treatment. It is important to discuss the rocking with your provider. With that said, that could also be caused by someone's mood disorder (why discussing with your provider and getting their assessment is so important). Thank you again, - Dr. Pagnani

[@aphysique]

Any good for Tbi patient's experincing irratability etc?

[@privatedeletebuttongooglei5221]

Medical malpractice lawsuits are not happen8ng enough.

[@usaidneog3909]

Will I gain weight on divalproex if yes then how to lose with this medication

[@maamourr8170]

Depakote gave me insomnia:(

[@JamesHopton-ek7ct]

I Very Allergic to Depakote

[@CynthiaBlanchard-y2q]

How long does it take to work?

[@RittenhousePsych]

Thank you for your question. This would be variable, individual to individual, but in general I find that the full effect of a dose, will occur 3-4 weeks after starting that dose. Sometimes doses need to be titrated, before an effect occurs. It's very important to only adjust doses under the direct supervision of one's provider, and if there are concerns about the medication (or response), to also discuss that as well. I hope that this is helpful. Best, - Dr. Pagnani

[@themissfyris1519]

the fact that you cant categorize witch individuals will respond well and with what prevelent side efects based on category of individuals (or at least dont go into depth for every single person )tells me its either pseudoscince and actually doctors dont know much compared to all other meds used other than psych meds or you just dont bother going into such detail witch you should considering they are mind altering drugs

[@themissfyris1519]

would appreciate an answer doc i was actually prescribed depakote er

[@evacameron8670]

No this drug is garbage

[@evacameron8670]

Lawsuit drug call a civil l

[@evacameron8670]

Get a civil attorney

[@privatedeletebuttongooglei5221]

Is not amoxcillin

[@privatedeletebuttongooglei5221]

Is not an antibiotic

[@perfectlyundonecustoms]

When was that inferred?

[@RichardRuvalcaba-rt3rr]

🎩🎩🎩🎩🎩🎩🎩🎩🎩🎩🎩🎩🎩🎩🎩🎩

[@evacameron8670]

Clumbsy falls and easy bruising and weight loss from Vomit

[@evacameron8670]

A Josie king story of death

[@denisecox3125]

I never knew how much my Divalproex helped until I went without it 2 months. Was going to stop because I was eating so much but I reached a low low with my Bipolar and it lasted for two months. My manic episodes became so stressful that I ended up having major anxiety and panic attacks. So thankful that I have a new prescription and will finally get some relief. 💚🩵

[@RittenhousePsych]

Thank you so much for sharing your experience. - Dr. Pagnani