What we’ve said about Valproate

“Lamotrigine. which is the weakest, but also probably the best tolerated. We have lithium, which is the gold standard, the classic. And we have Depakote. Works great. There are some problems with it, especially with both male and female fertility”

“Significant irritability and aggression. There is some clinical wisdom that helps, and I do believe there is some effect there. People with a legitimate migraine condition, Depakote can help prevent the frequency and severity of migraine headaches”

“if you have any schizophrenia spectrum disorder and you have any hint of mood problems on either pole, add a mood stabilizer. If it's agitation, probably try Depakote first along with impulsivity. That may help. And if it's anything else, lithium, lithium, lithium”

“people with history of TBI-induced neurocognitive or mood changes may benefit from lower levels of Depakote even without the bipolarity”

“the idealistic bipolar patient, the patient with euphoric mania and then with intermittent episodes of depression. That is considered the idealistic lithium patient. Depakote has some evidence with rapid cycling. It has some evidence with mixed episodes”

“Is it probably less efficacious than Depakote, Lamotrigine, and Lithium? Probably. But I also think that at higher doses, it may actually be more efficacious than Lamotrigine. If it's the right patient, it's actually not that bad”

“The valproate, the The teratogenicity makes it so that women absolutely should not be using it, period. And if you have a woman who's on the medication, you pretty much have to taper it off if they're talking about pregnancy planning”

“Why would you start a patient on a medication that in the next five years, next 10 years, you know that you're going to have to taper them off”

“There's a study showing that Depakote works better in mania if given with folic acid. And we know that Depakote tends to deplete folate, so it makes sense to give it”

“high levels of lithium guarantee you decline of kidney function. High levels of Depakote do not guarantee any end-organ dysfunction necessarily. You've got to monitor for it, but it's not a guarantee. You're pretty much looking out for a low platelet issue. Hyperammonemia, the liver producing too much ammonia”

“valproic acid jacks up the levels of lamotrigine. So the way I remember it is when you combine those two medications, it's the dangerous interaction. So increasing lamotrigine is what we're scared of because of SJS. So whenever you're interacting using those medications, you should half the lamotrigine”

“Myoclonic jerks are a warning sign before they get a seizure. So... Another thing is you don't necessarily have to stop the clozapine just because the patient gets a seizure. So typically Depakote is what's going to be used to treat it”