Stability at Lower Med Doses?
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Q:  Stability at Lower Med Doses?

I am a 42-year-old man and I'm 6-2 tall, weight is about 220.  I've put on 20 pounds of Depakote weight.  My psychiatrist has been quite sympathetic about the situation and we've lowered my daily dose from 1000mg to 500mg.  We hope the side effect of weight gain will diminish somewhat, but my doc isn't expecting it'll stabilize me at a low dose.  Blood level at 1000mg was 58mcg, which I know is at the low end of the therapeutic window.  Can some people remain stable at lower than recommended doses?

Dear Glen -- 
Yes, some people can remain stable at very low doses.  The new "ER" (extended release) version of Depakote seems to promote less appetite increase and weight gain, so if your symptoms return at the lower dose you can try going up again using the ER version and see if you can get away without the weight increase tendency again.  Otherwise I go back down to the lower dose again and add a little bit of another mood stabilizer, like low-dose lithium, usually.  

Dr. Phelps

Published December, 2002


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