Depakote-Appetite-Weight Gain
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Q:  Depakote-Appetite-Weight Gain

Dear Dr. Phelps:

I have just begun to take 750 mg of Depakote per day (have only been taking the full 750 mg. for a week now), and nothing earth-shattering has happened except 1) I am calmer and much less irritable; 2) I still have emotions but they are subtler, not like being hit in the head with a two by four (I suppose these are more like normal emotions) - I even find myself happy in a relaxed rather than an excited way; 3) This summer, I do not feel better, smarter, etc. than everyone else including my husband, feel that I have married way below me and feel very tempted to have affairs with the men I believe I "deserve".  If this keeps up, I imagine I won't feel by late fall or winter that I'm genetically defective, don't deserve the men I was fantasizing about and that killing myself is the rational solution.  

From reports at Bipolar World and on another e-mail list, I expected to get ravenously hungry with the Depakote.  This hasn't happened, but I think I am going to gain some weight which, since I have maintained my weight about 15-17 pounds below normal, will make everyone cheer except me.  What I'm finding is that I can't stay hungry all day as I used to do (I sipped on skim-milk lattes all day and ate a meal at dinner).  During the day I was hungry but there was no "alarm" associated with the hunger - nothing said "This is critical - get something to eat".  Now I find I can't just ignore my hunger.  So I have reverted back to the practices I learned in Overeaters Anonymous (don't even ask why an anorexic would go there!) and am just eating at meals, but eating somewhat heavier meals to get me through the intervening time.

I find I'm more comfortable with the idea of gaining some weight than I have been in years.  Being very thin and "perfect" and "not being a prisoner of my limbic system" as I used to say, was always part of my manic mindset.  I really believed I had superior powers beyond those of ordinary people to stay fashion-model thin.  Of course, after the hypomanic periods peaked, I would start eating uncontrollably for a month or two, gain a few pounds and get suicidally depressed.

Can you explain the mechanism by which Depakote affects appetite?  I'm thinking if I understand a little more what is happening with me, I may be better able to cope with the actual experience of seeing the scales go up *and* perhaps exercise some control over the process so as not to become overweight.

Oh, I also exercise (run) regularly.

Thank you,

Dear Ms. P'
Thank you for your very nice description of what it's like when a mood stabilizer works well.  I had to respond to your letter just to be able to "print" such a nice comment, even though -- darn -- I don't have much of an answer for your question.  No one really knows where that weight gain comes from.  The manufacturer thinks its because Depakote can irritate your stomach, making you want to eat to decrease the irritation-sensation which can be mistaken for hunger.  Uh, not sure that really matches with people's experience on this medication.  However, their new "extended release" formula (500 mg "ER") does seem to cause at least somewhat less weight gain.  You might try switching to see what happens to the appetite thing you experience, at least once your weight is in the healthy range.  But be careful: the new form is only about 80-85% absorbed, so 1000 mg is really more like 850mg; and 1500 mg more like 1275, and so on.  

Dr. Phelps

Published July, 2001


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