Most commonly Prescribed Psychiatric Medications: Valproate/Depakote

Valproate is FDA approved for acute mania, but not for maintenance treatment in bipolar disorder. Other indications include seizure and migraine headaches. This video covers MOA, clinical uses, and side effects of this commonly prescribed medication for bipolar disorder.
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Disclaimer: This is not medical advice, and the information is provided for educational purposes only. Please consult your doctor for any specific medical questions.
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[@gorgoniomendoza7648]

I have severe epilepsy. This helps about ninety percent of the time.

[@eliallen3860]

I’ve always assumed Depakote is most effective for treatment resistant physical aggression in Bipolar (when antipsychotics like Seroquel, or Abilify or Zyprexa adjacent to the SSRI like Zoloft or Lexapro have failed) or for Intermittent Explosive Disorder.

[@gregula8080]

Thank you for this info. I have a frontal lobe TBI on both left and right and started taking Depakote. It certainly helps slow things down so all is not completely overwhelming. So far so good, but not thrilled about taking it for the rest of my life. I'm 42 and am hoping to find an alternative that works well and is less "dangerous"? maybe that's the wrong word. TBI from car accident at age 14. Symptoms are getting worse, especially over the past few years.

[@benjamintausheck6368]

I love the videos. So informative and easy to follow. I would love to see timestamps for certain areas like pharmacology, indication, dosing, side effects, contraindications, off label uses, etc.... Just to make it easier to move around to specific points. Can it be used as an adjunct treatment for anxiety?

[@ShrinksInSneakers]

appreciate the comment, I need to make the videos shorter and easier to navigate, I love talking about this stuff so it's sometimes hard to stop

[@benjamintausheck6368]

@@ShrinksInSneakers I think the videos are a great length! I think that if we just have timestamps it'll be easy to jump around. Sometimes I have questions at the end but I go back and see that you had already explained it so if I had the timestamp it would be easier to find. Keep up the fantastic work! You inspire me to want to practice psychiatry!

[@ShrinksInSneakers]

@@benjamintausheck6368 appreciate it, I'm always looking to get better and add more value

[@benjamintausheck6368]

I would love to see a video on atomoxetine versus guanfacine versus clonidine for ADHD! Hope everything is going well for you and your loved ones!

[@ShrinksInSneakers]

@@benjamintausheck6368 sure its a good topic, I have some friends who love to use a clonidine patch for anxiety and believe it works better than most other medications for the physical symptoms of anxiety. Just to provide some insight I would start with stimulants as the most effective treatment, atomoxetine as a second line option, and guanfacine as a third line. This order has to do with both efficacy and side effect profile. ope this provides a little insight on the medication selection

[@markparfett5380]

Should all use of alcohol be suspended or is low consumption 2 to 3 units 2 to 3 times a week ok?

[@avrylllorraine7568]

I just started and I've noticed I don't go to my phone as much .

[@jaelinwhittaker9724]

I need this medicine

[@TheZorba2000]

What is good to use with valproate for depression pls

[@The_New_Abnormal_World_Order]

After 7 years, valproic acid has ravaged my body

[@paulzaker5395]

Thanks for the video. Is there a typical time frame that a patient can expect to begin to see efficacy when Valproate is used for mania or agitation/anxiety?

[@ShrinksInSneakers]

If you do a weight based dosing of 20-30 mg/kg you should see results quick. The half-life is about 12 hours so steady state can be reached quicker, and I’m talking about depakote DR, I don’t like ER personally and doses need to be adjusted by 10-30% higher if you use ER. The benefit of ER is once daily dosing. I really think this medication has some serious benefits in many disorders. Hope this helps if you haven’t subscribed to the channel please do and spread the word. I’m also posting daily on Instagram check out the page and follow us there too.

[@tonimarie6270]

Hello - my 20 year old was prescribed 250 mg depakote ER 3 times daily by an in patient facility dr - shouldn’t it be only once a day since it’s ER - this would be for bipolar Thank you - he has an appointment in two weeks with dr

[@renegadejane6122]

How severe are the liver risks? Depakote worked wonders for my moods I felt like; but the black box liver warnings caused me to stop it.

[@shanegsxr3303]

Same here I took it for a while but the liver faliure warning is scary got blood work done while on it and liver enzymes were high with fatty liver

[@jocs8824]

As this medication is inhibitory via gaba effects, how hard is it to stop if required after being on it for several months min. ? Is it like stopping benzodiazepines as they create awful physical dependence withdrawal symptoms in many who take them beyond a few weeks/months?

[@The_New_Abnormal_World_Order]

You have to reduce very slowly

[@truehuman9449]

Does it affect sleep? I take only morning ER dose for seizures? Age 51 wighing 188 pounds? Is this optimum?

[@sam_i_am_.]

What are your thoughts on mood stabilizers for patients who do not have Bipolar Disorder; perhaps those with Borderline Personality Disorder?

[@ShrinksInSneakers]

I like something called good psychiatric management for borderline PD. Do a quick google search and see if it might be of value for you. The medications are there to treat comorbid disorders like depression or bipolar. I do not think they have a place if the only diagnosis is BPD. Other options include the gold standard DBT or metallization therapy. Hope this helps

[@allison3333]

Hey I found myself here because I was hospitalized for seizures. I have a history of BPD and trauma based events caused me to go into non epileptic seizures. They gave me sooo much depakote. It saved my life.

[@eduprosusacollegeconsultin6743]

I'm take 1000mg depakote er and lithium 900mg , is this just a unnecessary duplication?

[@justinenigma1908]

I’m gonna die from bi polar. My energy is so high I can’t think. I have brain fog. And then my body is too tired to move. This is the worst feeling ever. I have acute mania. Tried lamotrigine and it made me worse. Should I try depakote. I change my mind every two seconds. It’s really painful.

[@ShrinksInSneakers]

This is not medical advice, it’s for educational purposes only. Always talk to your doctor prior to making any changes. The primary mood stabilizers for acute mania are Depakote DR, Lithium, and Carbamazepine. These have the most evidence and would be the ones I look to in acute situations. Some dopamine blocking medications can also help with mania they include olanzapine, risperidone, Seroquel, Cariprazine, Haldol also has some good data but is a second line option in my mind. I hope this helps, if you haven’t already, please like and subscribe to the channel and spread the word about what we are doing here. We also have daily Instagram content it may be of interest check it out.

[@lindamastropietro4429]

I’m sorry you’re having these feelings.

[@TheZorba2000]

Does sodium valproate help with depression

[@user-cd1fj4gx2i]

Maintenance depakote has been around for decades and in certain individuals via self reporting more effective than lithium ... generally those who have dual diagnostic sud dxes

[@benzapp1]

Does anything besides lithium really have evidence of prophylaxis? I feel like there is a great deal of debate over what really works long term. Substance use disorder doesn't get enough attention for Depakote. So too carbamazepine. A decent topic.

[@user-cd1fj4gx2i]

@benzapp1 not at all uts first lime of treatment for those with dual dx of Sud and bipolar not to mention depakote is also used for Sud alone for cravings and detox... you really need to further your education... you're obviously no expert

[@benzapp1]

@@user-cd1fj4gx2i I think my comment was pretty clear that a video on this topic would be a "decent topic". This is subtle way of indicating to Dr. Rossi it would be a cool video for an idiot like me.

[@user-cd1fj4gx2i]

@@benzapp1 I think its pretty clear that a user like you is not the only person on the internet and that as providers in this field it is our job to educate the masses not pander to one specific person

[@benzapp1]

@@user-cd1fj4gx2i I'm really perplexed why you've taken this antagonistic stance. I'm just expressing curiosity.

[@joshuapittman7070]

I had depakote prescribed to me I was afraid to take it the nurse practitioner said I was not bipolar and I do not have seizures so I don't know why she would use this as a mood stabilizer.

[@ShrinksInSneakers]

Not sure on this one

[@tfoxen7518]

I have been prescribed 250 mg 2x/day for chronic musculoskeletal and joint pain. DOB 1961. Fit 105 lb female. History of Guillain-Barre Syndrome 2005., with nerve injury residual. Lumbar mild deg. After looking at research, I feel my symptoms are not a valid indication for this medication. Thoughts? Thanks in advance.

[@MehulPatelLXC]

Which medication? The lithium or depakote?

[@tfoxen7518]

Depakote @@MehulPatelLXC

[@lindamastropietro4429]

I take Lamictal 100 mg twice a day. I have Significant hair loss

[@ShrinksInSneakers]

Everyone is an individual and rare side effects can occur so I never say things can’t happen, but this is not considered a common side effect of lamotrigine outside of the context of toxic epidermal necrolysis in which alopecia is known to occur. Hope this helps, if you haven’t subscribed to the channel please do and spread the word about what we are doing here.

[@iairbarajas6652]

I read that another side effect of depakote is hair loss, how will know if its the medication or its just natural hair loss

[@ShrinksInSneakers]

This is true Depakote can cause alopecia although it’s unusual. Multivitamin fortified with zinc and selenium may help reduce the risk. The extended-release version of this medication has been shown to decrease the risk of alopecia. Also, lower doses have less risk. If a patient has significant hair loss after starting the medication and did not have any issues with hair loss prior, it’s more likely to be medication related. You would use your clinical judgment during follow ups and monitor.

[@angelaperry2070]

How do I wean of of 750mg divalproex. I've been on it for only 5mths?

[@ShrinksInSneakers]

I would talk to your doctor, I can't provide that type of direct advice here. They should be able to provide you a simple plan for coming off this is a low dose. Sorry I can't be more of a help, if you haven't subscribed to the channel please do and spread the word about what we are doing here

[@butterboy5621]

Interesting that there is really zero evidence of effectiveness for treating agitation/aggression in dementia using depakote.

[@ShrinksInSneakers]

Most treatments for acute agitation are off label uses, and I would say dopamine blocking medications are more commonly used in these cases. I agree it would not be my go to medication.

[@butterboy5621]

@@ShrinksInSneakers Limited evidence for Seroquel, abilify, zyprexa, and risperidone...but associated with risks I usually try low dose trazodone before antipsychotics. I still see some that believe in depakote for that indication...but hard to justify it based on the available evidence.

[@ShrinksInSneakers]

@@butterboy5621 Agitation in dementia is situation that you will almost alway be doing things with limited evidence. I would actually start with donepezil and melatonin if the patient is not already being treated with AChE inhibitor. Theres some evidence to support its use for the behavioral disturbances. this obviously depends on how agitated the patient is and risk for harm to the patient or staff. Melatonin is a good for patients who present with delirium in the setting of dementia. This is good discussion on a topic that is largely dominated by doctors personal preferences for medication selection. I believe they are also looking at pimavanzserin for dementia related psychosis may be another option in the future

[@butterboy5621]

@@ShrinksInSneakers there's an excellent book called BPSD by Art Walazek that many consider the bible on the topic. Art is a geriatric psychiatrist and pillar of local Alzheimer's Association up here by me at the University of Wisconsin Madison. It's definitely worth getting if you work with this patient population. It's a great compilation of the newest and most relevant evidence, guidelines, and expert consensus.

[@ShrinksInSneakers]

@@butterboy5621 appreciate the tip I'm always reading

[@JerichoEden]

Do you like to watch me?