Should the Depakote be Augmented or Should Meds be Switched?
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Q:  Should the Depakote be Augmented or Should Meds be Switched?

I appear to be of the bipolar II variety as I do not suffer from manic episodes but have severe depression and anxiety and antidepressants do not work. I have been on Depakote 250mg for 2 months and my depression has all but disappeared but my anxiety level has been consistently higher and I am somewhat irritable. 

I don't want to give up the depression relief but can't be this full of angst.  Should I switch meds or is there a med that would augment the Depakote? I can put up with the irritability.  

Thanks for all the info. Your opinion is greatly appreciated. 



Dear Kirk --

The good news is that you have found something which has a degree of benefit.  Now the challenge is to improve on that.  Should you switch, or augment? 

This has not been studied systematically (We are just now getting around to it in the study of depression, where a recent large clinical trial compared switching versus augmenting.  Interestingly, they both worked about equally well in that study).  Either would make sense. 

Of course, it is best to get all the mileage possible out of anything you try, before moving on. Typical doses of Depakote are usually in the range of 1000-1500 mg.  You might be hesitant to turn it up, thinking that it has already caused anxiety and irritability.  Might these be worse if you turn it up? 

Depakote generally does not cause these symptoms.  Indeed, we use it to treat them.  Statistically, it is probably far more likely that what you are seeing is symptoms of your illness untreated by Depakote, rather than sometimes precipitated by Depakote.  However, once in awhile, nearly anything can happen, so I could not be absolutely confident about that. 

If you had been on an antidepressant just prior to going on the Depakote; and if that antidepressant was stopped when the Depakote was begun; then it is possible that these symptoms have come from the stopping of the antidepressant, rather than from Depakote itself. 

In any case, talk to your psychiatrist about the pros and cons of turning up Depakote before you go on to another strategy.

Dr. Phelps

Published August, 2008


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