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Depakote for bipolar disorder: What to know

Depakote for bipolar disorder: What to know

Depakote is an antiseizure medication that can help treat mania and mixed episodes of bipolar disorder.

Reviewed by:
Austin Lin, MD
|
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June 6, 2024
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Key takeaways

  • Depakote is generally not recommended if you’re breastfeeding or pregnant.
  • It comes in multiple formulations, including capsules and sprinkles.
  • If you experience bipolar depression, you may need another medication, other than Depakote, help relieve those symptoms.
In this article

If you have bipolar disorder (BD), you will experience the “lows'' of depressive episodes and the “highs'' of manic episodes. Psychiatric medications are a common and effective way to treat bipolar disorder.

One medication psychiatrists often prescribe to treat bipolar disorder is Depakote, the brand name for divalproex sodium. Medication can help level out intense mood episodes and prevent both manic and depressive symptoms. Depakote tends to work primarily for mania and mixed episodes, while not being as effective for bipolar depression.  

Read on to learn about how Depakote works, what it treats, side effects, risks, and more.


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What is Depakote and how does it work?

Depakote is technically an antiepileptic drug or valproate which means it’s used to prevent different types of seizures in people with epilepsy. However, it can also help people with bipolar disorder who are having manic or mixed episodes.

Depakote’s mechanism of action is thought to be related to how it impacts gamma-aminobutyric acid (GABA). GABA is a neurotransmitter, a chemical messenger in the brain, that’s linked to feelings of calm and relaxation.  Depakote increases levels of GABA in the brain –– and in turn, this can help reduce manic/mixed episode symptoms.  (It also blocks voltage-dependent sodium channels, which results in suppression of high-frequency repetitive neuronal firing.)

What conditions does Depakote treat?

Depakote (or valproate) has three FDA-approved indications, including:

  • Treating mixed or manic episodes in people with bipolar disorder
  • Treating seizures in people with epilepsy
  • Preventing migraine headaches  

Clinical trials have found Depakote to be effective for all three of these usages.  

Doctors can also prescribe Depakote off-label, which means using a medication for an indication other than what the FDA has approved. For example, it may be used to reduce agitation and aggression in people with traumatic brain injury.  

How do you take Depakote for bipolar disorder?

Your doctor will tell you exactly how to take Depakote. However, it is often administered in a divided dose, meaning you take it more than once a day.  

The starting dose of Depakote is typically 500-750 mg per day, and then your doctor may increase the dose to achieve optimal symptom relief based on your symptoms. The dose you end up on is also based on your weight, with the max dose topping off at 60 mg per kilogram you weigh per day.  

Once you reach your recommended dose, it might take a few weeks to feel the full effects of the medication and evaluate if it’s having a significant impact on your mental health.  

Depakote is available to take in multiple forms, including:

  • Capsules
  • Delayed release tablets
  • Extended-release tablets
  • Sprinkle capsules (which you can open and sprinkle onto food)
  • Oral solution (a syrup)

It’s best to take Depakote around the same time every day. If you miss a dose, just take it as soon as you remember to do so unless it’s very close to the timing of your next dose. In this case, you should not take a double dose. Call your pharmacy or doctor if you’re unsure about what to do about missed doses.

How does Depakote make you feel?

If Depakote is working for you, it will make you feel leveled out and stabilized. Your mood will be at a more neutral baseline rather than experiencing deep depression or severe mania.  

For example, if you start taking Depakote during a manic episode, you may notice that symptoms like agitation, euphoria, and risky behavior choices will lessen.  

Depakote is more likely to mellow you out and calm you down rather than energize you. It’s also possible that you may experience side effects, especially when you first start taking the medication.

What are the side effects of Depakote?

Taking Depakote comes with the risk of experiencing adverse effects. Possible common side effects include:

  • Drowsiness
  • Headaches
  • Dizziness
  • Nausea  
  • Vomiting
  • Abdominal pain
  • Diarrhea  
  • Constipation  
  • Changes to appetite (increased appetite or loss of appetite)
  • Changes to weight (weight gain or loss)
  • Feeling weak
  • Tremors  
  • Ringing in ears
  • Vision disturbances (blurred vision, double vision, or unusual eye movements)  
  • Trouble with walking or coordination
  • Hair loss
  • Flu-like symptoms  

It’s possible that side effects might be worse when you first start taking the drug and then lessen over a few days or weeks. Carefully monitor how you’re feeling, and if your side effects won’t go away or worsen, contact your doctor to develop a plan for proceeding.  

There are also more severe, serious side effects, which are more rare, including:

  • Suicidal thoughts or behaviors
  • Hepatotoxicity (liver damage)
  • Bleeding problems
  • Hypothermia (dangerously low body temperature)
  • Pancreatitis (inflammation of the pancreas)
  • High levels of ammonia in the blood
  • Birth defects to a fetus if you’re pregnant

If you’re experiencing any severe side effects, contact your doctor immediately. They can run tests, such as blood tests, to see if you’re experiencing any of these severe complications.  

If you have any specific concerns about side effects before starting Depakote, talk to your doctor.

When not to take Depakote

There are certain situations where Depakote is likely not the best fit for you, usually based on preexisting medical conditions you have.

Contraindications for taking Depakote include:

  • If you have liver problems such as liver disease or dysfunction  
  • If you have a mitochondrial disorder  
  • If you have a known hypersensitivity to valproate
  • If you have a urea cycle disorder

If you experience any of these, let your doctor know so they can discuss other treatment options.

Depakote during pregnancy and breastfeeding

Additionally, if you are pregnant or planning on getting pregnant soon, you should have a serious conversation with your psychiatrist and OB/GYN. If you take Depakote while pregnant, there is a greater risk of the baby having:

  • Birth defects
  • Neuro-developmental disorders
  • Decreased IQ later in life

For these reasons, your doctors will likely recommend considering a drug rather than Depakote to manage your bipolar disorder. If you’re a woman of childbearing age taking Depakote and don’t want to get pregnant, the FDA suggests using birth control to prevent pregnancy. There are several other bipolar medications that have more safety data in regards to  pregnancy, so Depakote is generally avoided unless there is no other option.  

Similarly, it’s not ideal to breastfeed while taking Depakote since the medication can be transferred to the baby through breast milk.  Make sure to discuss this with your psychiatrist and OB/GYN, too.  

Drug interactions

There are drug interactions to be aware of, as well. Some major drug interactions include:

  • Hepatic enzyme-inducing drugs
  • Other anticonvulsants/antiepileptic drugs like Depakene (valproic acid)
  • Certain antidepressants
  • Certain antibiotics
  • Warfarin
  • Aspirin  

This is not an exhaustive list of drug interactions. Make sure to tell your doctor about all over-the-counter and prescription drugs you take to ensure that there aren’t any dangerous interactions.  

Other medication alternatives to Depakote for bipolar disorder

The goal of treatment with Depakote is to reduce the severity of intense mood episodes and to level out your mood in general. The medication can be very effective and helpful in people who are good candidates for Depakote.  

It is also common for patients with bipolar disorder to take a second medication to help with bipolar depression (if they experience it), given that Depakote tends not to address bipolar depression as effectively.

If Depakote isn’t the right fit for you due to side effects or contraindications, there are other options of medications for treating bipolar disorder, including mood stabilizers (such as lithium), other seizure medications (such as Lamictal), and atypical antipsychotics (like Abilify). Therapy can also play a large role in bipolar disorder treatment.

If you think you might have bipolar disorder, getting a diagnosis is the first step. Getting treatment can make a huge improvement in your symptoms and overall quality of life. If you’re looking for a psychiatrist to diagnose you and potentially prescribe medication, consider Talkiatry.  

We’re a national psychiatry practice that treats a variety of mental health conditions, including bipolar disorder and co-occurring conditions. We provide virtual, in-network services so you can get the care you need from home. To get started, complete our free online assessment to get matched with a psychiatrist

FAQs

What kind of medication is Depakote?

Depakote is an anticonvulsant or anti-epileptic medication. Even though it belongs to this class of drug, it is still beneficial for bipolar disorder due to its effects on GABA in the brain.  

Is Depakote addictive?

Depakote is not addictive, and it is not a controlled substance. It’s safe and effective for the treatment of bipolar disorder. If you have more concerns, talk to your doctor.

What should I know before taking it?

Before taking Depakote, you should be aware of potential adverse effects, including dangerous, serious side effects. You should also know what pre-existing health conditions could make you ineligible to take Depakote. Additionally, if you’re pregnant or planning on becoming pregnant, it’s important to know about the risks that Depakote poses to pregnant women and their babies.

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.

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Does Talkiatry take my insurance?

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Call the number on your insurance card and ask about your plan’s coverage for outpatient psychiatric services.

How does Talkiatry compare to face-to-face treatment?

For most patients, Talkiatry treatment is just as effective as in-person psychiatry (American Psychiatric Association, 2021), and much more convenient. That said, we don’t currently provide treatment for schizophrenia, primary eating disorder treatment, or Medication Assisted Treatment for substance use disorders.

What kind of treatment does Talkiatry provide?

At Talkiatry, we specialize in psychiatry, meaning the diagnosis and treatment of mental health conditions. Your psychiatrist will meet with you virtually on a schedule you set together, devise a treatment plan tailored to your specific needs and preferences, and work with you to adjust your plan as you meet your goals.

If your treatment plan includes medication, your psychiatrist will prescribe and manage it. If needed, your psychiatrist can also refer you to a Talkiatry therapist.

What's the difference between a therapist and psychiatrist?

Psychiatrists are doctors who have specialized training in diagnosing and treating complex mental health conditions through medication management. If you are experiencing symptoms of a mental health condition such as depression, anxiety, bipolar disorder, PTSD, or similar, a psychiatrist may be a good place to start.  

Other signs that you should see a psychiatrist include:  

  • Your primary care doctor or another doctor thinks you may benefit from the services of a psychiatrist and provides a referral    
  • You are interested in taking medication to treat a mental health condition  
  • Your symptoms are severe enough to regularly interfere with your everyday life

The term “therapist” can apply to a range of professionals including social workers, mental health counselors, psychologists, professional counselors, marriage and family therapists, and psychoanalysts. Working with a therapist generally involves regular talk therapy sessions where you discuss your feelings, problem-solving strategies, and coping mechanisms to help with your condition.

Who can prescribe medication?

All our psychiatrists (and all psychiatrists in general) are medical doctors with additional training in mental health. They can prescribe any medication they think can help their patients. In order to find out which medications might be appropriate, they need to conduct a full evaluation. At Talkiatry, first visits are generally scheduled for 60 minutes or more to give your psychiatrist time to learn about you, work on a treatment plan, and discuss any medications that might be included.

About
Austin Lin, MD

Dr. Austin Lin is a double board-certified adult and addiction psychiatrist who has been in practice for over 9 years. At the center of Dr. Lin’s clinical approach is a strong emphasis on establishing trust and using a collaborative approach to help patients develop an individualized and cohesive plan so that they are able to achieve their goals.

Dr. Lin's practice focuses on medication management. Typically, he offers this in conjunction with supportive therapy, motivational interviewing, and/or cognitive behavioral therapy in 30-minute follow-up visits. Occasionally, Dr. Lin may recommend that additional therapy is needed and ask that you bring a therapist into your care team in order to provide the best outcome.

Dr. Lin received his medical degree from St. George’s University School of Medicine. He went on to complete his residency in psychiatry at Harvard South Shore, an affiliate of Harvard Medical School, where he served as Chief Resident and earned his 360° Professionalism award. He then had additional training in Addiction Psychiatry through his fellowship at the University of Texas Southwestern Medical Center. After completing training, Dr. Lin has worked as an Addiction Psychiatrist and Director of Adult Services in the Trauma and Resilience Center (TRC) at the University of Texas Health Science Center at Houston (UTHealth). He specialized in treating patients with a history of depression, anxiety, trauma, and substance use disorders.

Dr. Lin has held an academic appointment at UTHealth, and he has spent his professional career supervising and teaching medical students and psychiatry residents.



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