Bipolar - Doc just renewed prescription with different meds?

Question

I've been taking Depakote for a year or so now, 250mg three times a day. It's been very good to me, feel better than I have in months. Or at least I did. Recently got my prescription renewed and my doc wrote it for Depakote ER instead of the standard Depakote I've been taking, dosage the same. (He never mentioned changing anything so I assume this was a mistake on his part.) My mood has crashed over the past couple of days. Anyone know if there is a difference in these drugs as far as dosage and times taken daily that can affect bipolar this badly this fast? Or am I just dropping into another of those wonderful black valleys of my cycle?

Answer 1

I also take the same amount of Depakote (250 mg. 3x) and once got switched to the Extended release. I called the doctor within just days, for some reason it did not work as well for me and I did not tolerate it well. It actually gave me heartburn.
My Psychiatrist just said it does not work the same for some people and I went back to the regular prescription that I had been on for 6 years.

Do you take an anti-depressant? I take Lexapro. This also works well for me.

Answer 2

The ER in your present prescription just means "extended release". I doubt that it was a mistake on your doctor's part. Extended Release, just means that there is a more even release of the medication into your bloodstream and is an improvement over the previous form.

There should be no change in the dosage. If you take them every 8 hours ( 3 tablets in 24 hours), that would be the optimum times.

I would not suspect that the change in your moods in the last 3 days are the result of your new prescription as long as it is the same Depakote brand and not 2 different generic companies. Sometimes 2 different generic manufacturers have different amounts of the medicine in the tablet because of better or worse quality controls in their manufacturing process.

I would encourage you to call your doctors office and talk to your doctors nurse about this in any case. As you probably know, the sooner you get back to a stable mood, the better.

My best wishes for you that your improved condition continues.

Answer 3

I am bipolar also and I recently found a book that has helped me called: The Bipolar Disorder Survival guide. In it I read that normally a person with bipolar disorder needs 2 different types of medication in order to completely control the disorder. We need an antidepressant for the depression and something for the manic stages too (the only thing coming to mind that it mentioned is Lithium). Just taking one or the other will most likely throw you into the opposite state at a larger degree. I would suggest getting this book because it helped me immensely, not only with meds but also with coping skills and helps loved ones understand the disorder also.

Answer 4

1

Answer 5

I'm only just learning about bipolar disorder, as I'm SURE my husband has it (he's in denial). Here's one site that might help (btw: Depakote and Tegretol, tho' accepted, are pretty OLD meds!...I recall when my husband took Tegretol for seizures, he was sick as a dog!...maybe investigate new treatments?)...Also, He already takes Trileptal, which is mentioned on this site, but that doesn't seem to affect his manic episodes, nor does the Prozac he takes for depression!

Anyway, here's what I read at: http://www.mcmanweb.com/article-22.htm

"Consider this: There is no bipolar pill, and maybe there will never be. People with bipolar disorder simply represent too small a market (one to two percent of the population) for a pharmaceutical company to take a gamble on investing the $800 million the industry claims takes to get a drug to market, assuming, that is, such a drug ever leaves the lab. Since most new drugs originate from public sector research in the first place, the industry would virtually have to be handed their magic bullet on a silver platter. So it is that the bipolar community must pick and choose from a menu of leftovers designed for other populations - antidepressants, antianxiety medications, antipsychotics, and anticonvulsants. Last but not least, there is a common salt.
Lithium for Treating Bipolar Disorder

The story begins in an Australian lab in 1949 when John Cade MD, senior medical officer in the Mental Hygiene Department of Victoria, had a hunch that urea would be effective in the treatment of bipolar disorder. He needed an agent to help the substance dissolve in water, which turned out to be lithium. He quickly found the solution had a calming affect on guinea pigs, but further experimentation showed that it was the lithium and not the urea that was the active ingredient. He then tried lithium on human subjects, with eye-popping results.

John Cade's discovery of lithium as a treatment for bipolar disorder may be accidental, but the simple fact that the finding came in a lab demonstrated that at least one person on the planet back then recognized that the illness carried a biological component. In those days, in a world dominated by Freudian psychiatry and the belief that bipolar was an attitude problem, Dr Cade was way ahead of his time. It would take until the 1960s before his findings were applied in Europe and yet another decade before lithium became available in the US.

Lithium can be considered the first of the mood stabilizers - an agent that reduces the severe mood swings characteristic of bipolar disorder - and today it still remains the treatment of first or second choice. It was approved by the FDA for the treatment of mania in the 1970s and until recently was the only drug approved for maintenance therapy.

Early studies reported success rates of up to 80 percent for the treatment of mania, but more recent results show lithium to be effective in about 40 to 50 percent of subjects, perhaps reflecting its wider use on more unwilling patients.

The drug also works moderately well for treating bipolar depression.

Because of its high toxicity, blood levels need to be very carefully monitored. Lithium can be potentially damaging to the kidneys (where it is metabolized) and the thyroid.

Lithium and other mood stabilizers are believed to work through neurotransmitters outside the brain cell, resulting in a molecular series of events that leads through the brain cell's membrane via various ion channels and inside the neuron through signal transduction pathways (which involve a number of chemical chain reactions responsible for a vast array of cellular activities)." [ This site mentions the Depakote, but not your specific concern] Still: Here's something on combining meds or "cocktails":

"

At the 2003 American Psychiatric Association annual meeting, Frederick Goodwin MD cited several rationale for using combined therapy to treat bipolar, including:

* Targeting different symptom clusters. For example, a patient with a mixed state who rapid cycles and has substance dependence would suggest the need for an anticonvulsant while a risk for suicide would suggest the need for lithium. A Lamictal-lithium cocktail, on the other hand, makes for optimal prevention of depression and mania.
* Different mechanisms of action. Lithium and Depakote have multiple targets in the signal transduction pathways inside the neuron that may complement one another.
* Nonresponse or partial response. For example, one study of adding Zyprexa to lithium or Depakote found the combination kept patients well longer than either mood stabilizer alone.
* Side effects. Adding two meds together at lower doses may keep each drug below its side effect profile. One study of 140 bipolar I patients found 59 percent compliance with Depakote monotherapy, 48 percent compliance with lithium monotherapy, but 100 percent compliance with combined therapy at less than full doses."

For the record, I also read that certain benzodiazepines, esp. Klonopin or Valium have been used successfully to treat the manic phases. Sometimes other anti-convulsants are given in a loading dose.

It seems to be different with each person. Find a good neurologist, if you can.

I hope you can make sense of this...it seems that most doctors can't (don't just rely on your GP)! Good luck!

Answer 6

if I remember correctly ER mean "extended release", it means the medicine releases in your system at a different rate. call your doc and inquire, have him resubmit the prescription. it may be relasing into your blood stream at a slower rate.

Answer 7

ask your doctor if there is any difference in the previous and new medicines you are taking and tell the doctor you are having side effects with the new medicines.

mercury of love