Anyone know the average level prescription of Depakote?

December 23, 2005 4:22 PM

I have a family member who has recently been diagnosed with bipolar disorder type 2. The psychiatrist has prescribed them 1000 mg of Depakote a day, what is the average prescription if anyone knows? Is this a lot or only a minor dosage?

The news came as a shock to all of us (his family), while we suspected he was always prone to depression... we never knew this... Anyway, it comes out that it's been really bad and he has hurt himself, and spent all his scholorship money and nearly taken his life on more than one occasion. We just want to make sure he is all right and taken care of.

posted by nosophoros to health & fitness (13 comments total)

from: http://www.healthsquare.com/newrx/dep1125.htm

"MANIC EPISODES
The usual starting dose for those aged 18 and over is 750 milligrams a day, divided into smaller doses. Your doctor will adjust the dose for best results."
posted by TonyRobots at 4:33 PM on December 23, 2005

I have bipolar type two.

I have never been prescribed depakote but let me mention it is a med that is prone to make one gain weight.

About.com has a bipolar forum you will find useful. Also, it is more than typical that we have to try various medications until we find the one that works (I like to say it is like going to the perfume counter-what smells good on one person stinks on the next.) If this med doesn't give him the results it should make sure his doc works with him to find something that does. (lamictal is the magic bullet for me. YMMV here.)

Oh another thing-depakote is also notorious for hair loss-he'll need a mineral supplement to counteract this. (I think zinc and selenium are the minerals BUT the best thing is to simply have him take Centrum Silver which has what he needs in it.)

Feel free to email me if you have other questions-it's in my profile. And don't despair. You and he are over the biggest hurdle which is getting a diagnosis. Life will get better!
posted by konolia at 4:36 PM on December 23, 2005

I understand that this is an information-gathering question as a part of your process of coming to grips with this diagnosis, but other than that, is there something else that makes you doubt the psychiatrist's course of treatment?

I am just curious. Well, and "We just want to make sure he is all right and taken care of" combined with the actual question being RE: the dosage. If I found myself in a similar situation, I think there would be a rash of questions I would want to ask, but this would be pretty low on the list
posted by misterbrandt at 5:01 PM on December 23, 2005

Per RxList.com

DEPAKOTE tablets are administered orally. The recommended initial dose is 750 mg daily in divided doses. The dose should be increased as rapidly as possible to achieve the lowest therapeutic dose which produces the desired clinical effect or the desired range of plasma concentrations. In placebo-controlled clinical trials of acute mania, patients were dosed to a clinical response with a trough plasma concentration between 50 and 125 µg/mL. Maximum concentrations were generally achieved within 14 days. The maximum recommended dosage is 60 mg/kg/day.

There's tons more info there.
posted by redheadeb at 5:28 PM on December 23, 2005

I've been on depakote for the past 5 and a half years, though for seizure control and not bipolar. I'm also on 750mg; 1000mg is a fair amount, but by no means excessive.

I really cannot recommend this stuff highly enough. I can only speak to my own case, but I've experienced no side effects worth speaking of - no weight gain, no hair loss, a bit of occasional light nausea. I have had occasional problems with anemia, possibly as a result of the drug, but nothing that wasn't easily counteracted with a daily multivitamin.

If you have any questions, my email's in my profile, and I'd be happy to discuss the stuff. I've had no complaints with it; I can't speak to its effect on bipolar disorder, but as far as side-effects go, I'm a fan.
posted by ZaphodB at 6:08 PM on December 23, 2005

I take it too, but not for bipolar. I take it for persistant headaches. I'm with ZaphodB: For me it has been a great drug. I'm down from 6-7 mind blowing headaches per week to 2-3 mild ones. No side effects to speak of. I take 500mg a day.

I know that my doctor told me once that if the headaches persisted he would up the dose to 1000 mg, so I'm assuming from that conversation that 1000 is nothing to worry about.

It has been a life saver for me. I hope your luck is as good.
posted by crapples at 8:55 PM on December 23, 2005

As a practicing mental health person ..

1000mg is not a bad starting dose and it can be titrated upwards to based on serum levels. Have them check a level 3-5 days after taking this dose. A level under 100 is usually adequate for bipolar II patients.

It's important to note that there are many options to consider for Bipolar II and this depends on your brother's presentation. Allow me to present some points:

1) If your bro is primarily a Bipolar depressed individual with occasionally hypomanic episodes, worth considering a mood stabilizer with anti-depressant properties. There are two of them: lamictal and lithium.

2) Valproic Acid (Depakote) tends to be reasonably well tolerated, but has a significant burden of tremendous weight gain. It ranks up there with Olanzepine. Thus, if he will be sticking with this med, please have him start taking a good diet and exercising regularly. Also, diet portion size control will be critical!

3) Atypical antipsychotics can be used in relatively low doses for mood stabilization and may well offer a balance of side effect burden and efficacy. For a BP II patient, well worth considering Risperdal.

All in all, don't be alarmed and try to work with your Psychiatrist. Ask him these questions and see what he has to say.

If I were to end up with BPII and needed a mood stabilizer, I would really try to get placed on Lamictal as a first line as long as it wasn't otherwise contraindicated.

There is a GREAT site on Bipolar and other affective disorders with up to date information and stuff on this illness. It's at www.psycheducation.org. you can also check out www.crazymeds.com for the inside scoop on psychotropic medications. Both are going to be great resources.

Any way, good luck to you!
posted by bhenry at 9:32 PM on December 23, 2005

I know (from online) the fellow who put crazymeds.com together-I second the recommendation. He tells it like it is.

(And as bhenry already said, do try the lamictal if the depakote doesn't work out. It was an absolute wonder drug for me.
posted by konolia at 9:52 PM on December 23, 2005

I was on 1000 mg Depakine (which is another brandname vor Depakote the internet tells me) from about the age of 5 to 16.
It is unclear wether the medication prevented any epileptic fits as was the intention. But it had a pronounced sedative debilitating effect on me.

I think I'd be a much more happy person now if it weren't for that dose at that age.

But that's just me.
posted by jouke at 10:58 PM on December 23, 2005

The key to remember with Depakote is that the effects and side effects too [!] are directly proportional to the serum concentration. However, its so very hard to tell what kind of serum level you'll get on a given patient.

Thus, another person's reaction to 1000 mg/day is somewhat irrelevant -- they may be slow metabolizers and keep the drug around a longer time. It follows then that for such a person, it would be toxic!

Know this: Depakote causes weight gain and sedation. It has other side effects too. BP II is MDD with hypomania. Ultimately, BPII's are being treated hypomania (and perhaps lessening of the depression) but psychiatrists are shooting for NO mania. Consider the tradeoffs withe depakote. You'll see why lithium and/or lamictal are rapidly becoming first line for BP II.

In the end, Depakote is a FAST anti-manic agent that can be titrated in a flash. It's also dosed by level. This makes it an ideal med for BP I, especially inpatient units.

Lamictal, on the other hand, is much, much, much slower to titrate -- can take nearly a month. It costs more. It requires near perfect compliance due to the slow titration rate. And its a weaker mood stabilizer. BUT, it has next to no side effects when titrated and has anti-depressant activities. Guys, Lamictal was made for BPII.

Good luck to you!
posted by bhenry at 11:44 PM on December 23, 2005

I was on 1000mg of Depakote for bipolar disorder for a year or so (I went off it because it didn't really work for me, not because of any debilitating side effects). I found it really easy to tolerate...no major side effects apart from mild drowsiness, which lessened with time.
It was one hell of an easy ride compared to, say, lithium.
Anyway, it's a good med to try initially, and the dose is entirely reasonable as a starting dose.
posted by feathermeat at 12:02 AM on December 24, 2005

(Forgive the topic drift... but there's much more to dealing with bipolar than the medication, and bipolar is much more than ups and downs. I highly recommend the book Loving Someone With Bipolar Disorder for anyone with a family member or friend suffering from this. It's written for couples, but it's very illuminating and the information and coping strategies would be useful to anyone. I wish you all the best.)
posted by Tubes at 11:11 AM on December 24, 2005

My 2 cents: most of the information above is irresponsibly presented and can't be said with certainty to apply to any particular individual.

Ask the doctor who prescribed it, in the context of her relationship with the patient in question. If you're not satisfied with the answer, find another doctor.
posted by ikkyu2 at 12:17 PM on December 26, 2005