Posted by Ritch on February 16, 2005, at 0:14:13
In reply to Re: Does Depakote help with Depression or just Mania?, posted by theo on February 15, 2005, at 14:35:15
> > > So Depakote is hard on your liver? Did it give you cognitive difficulties, make you sloth like in general? How much did or are you taking and are you taking it once or twice daily, regular or ER version?
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> > I'm taking 250mg ER at bedtime, and then occasionally an extra 125mg of sprinkle midday. I don't get cog difficulties on Depakote as badly as with lithium or Trileptal and certaintly not as bad as Gabitril or Topamax. Depakote has been around a long time so all the bad stuff that's ever happened is all fairly well documented and there is a black box warning about rare possibility of hepatic failure and potentially fatal pancreatitis. The chances for the liver thing tend to decrease with age and it (Depakote) is generally riskier to use in younger rather than older people. Lithium, OTOH, tends to get more troublesome in older age groups (because therapeutic doses are close to toxic doses). I get liver function tests every so often and thus far have come up ok, so I'm not real worried. Depakote does produce some asthenia (muscle weakness), but then so does Keppra.. Did you notice the "rag doll" feeling on it? In my case it wasn't accompanied by any internal restlessness, that's why I think it may be an acceptable alternative antimanic for me.
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> > > I forgot to mention one thing about Keppra, I had to take it 3 times daily instead of just 2. The half life is 6-8 hours and I don't understand why the PI sheet doesn't suggest this. It even says it clears fast and doesn't really "build up", it's in and out. Keppra doesn't seem to smooth out to be able take twice daily, at least for me. What about you, how much and when do you take it?
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> > Yes, I did notice a mild "rebound" effect in the middle of the next day.. I went as high as 750mg/day. 500mg at bedtime + 250mg midday. Anyhow, I found that 250mg at bedtime was plenty enough for good sleep. 125mg doses during the day seemed to work ok. Probably two 250mg tabs per day (1 tab at bedtime, 1/2 tab twice during the day) probably would be the best dose for me. The trouble is that they price the stuff the same no matter what strength you buy, so you will pay $$$ for the convenience. Splitting unscored halves of tablets in two wind up with a lot of dust.. don't know if you noticed that or not :)
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> So are you going to stop Depakote ER and try Keppra alone for mania?Not *planning* to stop, but curious to see if it will work just as well or perhaps better. I don't know. Depakote has a generalized energy-reducing ability, BUT in the past year or two it seems to have declining antimanic efficacy and it definitely is *fragmenting* and screwing up my sleep architecture. Oddly enough, I took low-dose Neurontin for a couple of years without an "accepted" antimanic and didn't do really much worse than I'm doing now. Bottom line: If I can get similar or improved antimanic efficacy on a more "liver-friendly" drug that can be taken on a relatively long-term regimen and provide better sleep architecture, then I want to go there.
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> I know what you mean about the rag doll effect. It seems to lessen, or maybe I just get used to it, over time. What's weird is that it makes me physically weak, and mentally charged. Can you relate?I didn't get *any* cognitive sfx from Keppra. It did seem to clear brain fog if anything. I liked that. Just didn't like the PHYSICAL "lying around", LISTLESS feeling in the daytime. It was like a simultaneous "fearless feeling" AND "not driven to do much of anything either feeling". But, not feeling bummed out that I wasn't doing anything... but not really feeling numbed like on an SSRI.. I guess to sum up, it must be the asthenia I suppose that is the worst about it that I don't like.
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> When you were at 750mg, did you feel like it was to much? I know when I first start Keppra, I'm a little tired and once I hit 750mg I kind of get charged up, maybe even a little aggressive.I increased to 750mg relatively quickly. All I know is that 125mg at night wasn't enough for sleep, and 250mg worked fine. 250mg doses in the daytime *did* seem a little much. So, that's how I found out that 750mg/day was "a bit much". 500mg day total seemed just about right.
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> Would you say overall that Keppra is better with less side effects than Depakote ER for anxiety? I'm tempted to try it but at the same time don't know if I have it in me to try another med.
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>Gabapentin has been the best AC for anxiety that I've ever taken, hands down. Keppra is somewhat close to it in *some* ways. It is tough to compare Depakote to Keppra for *anxiety* because it is is difficult to determine at times just where that anxiety is coming from.
poster:Ritch
thread:457547
URL: http://www.dr-bob.org/babble/20050212/msgs/458568.html