Q. Is it safe to continue taking Divalproex sodium for a long time?

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

I have taken note of your mention that you have been on Depakote (Divalproex sodium) 250mg for a year, along with your past history of depression and previous use of Risperidone 1mg. I would like to understand whether you started taking Depakote during a depressive episode or if there was a history of mania.

Bipolar Disorder comprises two distinct phases:

1. Depression, characterized by low mood, reduced energy, decreased interest in enjoyable activities, poor concentration, low self-esteem, sleep and appetite changes lasting for around 2 weeks.
2. Mania, involving persistent elevated or irritable mood, heightened energy levels, reduced sleep need, concentration difficulties, excessive grooming, increased religiosity, and heightened sexual drive for about 1 week.

For depression alone, antidepressants may be prescribed, sometimes augmented with mood stabilizers like Depakote. For the first occurrence of mania, antipsychotics such as Risperidone are typically initiated, sometimes combined with Depakote. Patients experiencing both mania and depression are often prescribed mood stabilizers like Depakote in conjunction with treatment specific to each episode. Usually, for a single episode of bipolar disorder, a mood stabilizer is recommended for nearly 2 years of symptom-free periods, followed by tapering and discontinuation if there are no personal, financial, or occupational stressors.

Based on the information you have provided, you have been on Depakote 250mg for approximately two years without experiencing mania or depression symptoms. If there are no stressors in your life, discontinuing the medication could be an option. But, if you prefer to be on the safer side and continue the medication, I suggest undergoing liver function tests (LFT), lipid profile, complete blood count (CBC), and monitoring your weight every 3 months.

Thank you.

Hello,

Welcome back to iclinq.com.

It seems that you might have encountered drug-induced mania, which can occur in certain individuals while using antidepressants. Considering that you are currently free of mood symptoms and stressors, you could consider the following approach:

Over the next two months, gradually decrease the Depakote dosage to 125 mg. During this period, pay close attention to any mood fluctuations you may experience. These fluctuations could manifest as restlessness, changes in mood (either elevated or low), disruptions in sleep patterns, bursts of anger, irritability, or shifts in energy levels (increased or decreased).

Should everything progress smoothly during this period, you may proceed to discontinue the tablet.

Thank you.

Hello,

Welcome back to icliniq.com.

I appreciate your inquiry.

Given your experience of feeling lethargic and low on energy, it would be wise to undergo an evaluation for potential symptoms of depression. In addition, discussing your coping strategies with a professional is essential. While I am unable to initiate any prescription medications, I strongly suggest you consult a psychiatrist in your local area for a comprehensive assessment and further guidance.

Making certain lifestyle modifications can significantly impact depressive and anxiety symptoms:

1. Plan various activities during your free time apart from work, such as reading, writing, watching movies, going for a walk, or engaging in conversations with loved ones. This can keep your mind engaged and occupied.
2. Begin your day with stretching exercises followed by meditation to promote a positive start.
3. When facing stressful situations, practice deep breathing exercises (3 to 5 deep breaths) to help alleviate stress.
4. Spend quality time with friends and family, and do not hesitate to express your feelings when necessary.
5. Explore guided muscle relaxation techniques like JPMR (Jacobson muscle relaxation technique), which can be found online.

My role is limited to providing information and suggestions. For personalized guidance and potential treatment, I would suggest you consult a psychiatrist.

I hope the provided information proves helpful.

Thank you.

Hello,

Welcome back to icliniq.com.

I want to emphasize that discontinuing Depakote at this moment is not advisable, considering your current expression of stressors and feelings of fatigue. Upon undergoing a comprehensive evaluation, a psychiatrist can provide informed recommendations based on your mental status examination. This might involve adjusting the Depakote dosage or introducing another medication.

I encourage you to exercise caution when relying on information from online sources, as their scope is broad and it can be challenging to pinpoint relevant aspects.

I suggest you consult a psychiatrist in person to engage in a detailed discussion about your management plan.

While awaiting your appointment, you might consider trying the behavioral techniques that were suggested earlier.

Thank you.

Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Dr. Anantha Kalyan D

Experience: 6 + Yrs

Psychiatry

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