Depakote & Tianeptine
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Q:  Depakote & Tianeptine

Two questions re Depakote ER (all depakote varieties, actually). One question re different drug.

1. What can one do to minimize or  eliminate flatulence?
2. What can one do to keep hair from falling out and texturally getting thinner as well?
3. Is Tianeptine FDA approved? Is it worth a try if one experiences the above plus much short-term memory      
    trouble on Depakote ER(1000 mg/day) and Celexa (20 mg/day)?


Dear Mr. or Ms. C' -- 
Flatulence.  Hmm.  Not a huge problem for patients taking Depakote in my experience (according to the manufacturer's data, it's in the 1% to 5% frequency range).   Could be they're not telling me, of course.  Or it could be that you also have another related problem associated with flatulence, like irritable bowel syndrome (IBS; which could get better when the memory part gets better, I think -- if the memory problem is associated with continued mood/anxiety/sleep symptoms, which I hope is the case, because that would mean there might be a pretty simple way to help in that respect, and thus perhaps with IBS too if you have that).  OR, it could be that you'd never had a problem like this before and sure enough, whether it's been much of a problem for other folks or not, it's clearly a problem for you on this medication.  

In that last case, I fear I've got nothing special to offer (asking around on bipolar bulletin boards might lead you to something more useful).  There's the obvious "try a different medication" route, but I'm sure that's not what you were asking about.  Going on to one I recognize...

Hair falling out:  very common, as you've probably learned.  Some people get really good results from taking a multivitamin with selenium and zinc, as one can find in -- among others -- Centrum Silver.  Some people see no benefit at all, but other than cost there's not too much to lose there.  

And of Tianeptine:  not approved.  On the internet, though (frightening).  It's an antidepressant, I see.  Whoops, wrong idea there if you're already on Celexa.   (and ironically I note flatulence on the list of side effects...)

Now, getting a little more serious:  you may be familiar with the controversy about whether to use or continue antidepressants in people with bipolar disorder.  Here's my little essay on that controversy, summarizing some literature there.  In my view anyone who's still having mood symptoms or cycling, or sleep problems, or maybe even memory problems, deserves a trial on their mood stabilizers without an antidepressant on board at the same time.  Try talking with your doctor about that general idea.  You'll find more of my thoughts on treating with mood stabilizers on my BP II site, in the treatment sections.  

Dr. Phelps

Published January, 2003


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