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Outshined

Outshined: From antidepressants to Depakin

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Outshined

Hello to everyone!

 

My story is sadly very similar to a lot of other ones I've read here.

 

I was put on SSRIs when I was very young to be able to cope with panic attacks. It worked, but at the cost of annihilating my emotions and my vital energy. So, despite what my doctor said, I stopped taking Duloxetine (that was the last one that she tried on me). Regrettably, i did it almost cold turkey.

 

After four months of unbearable pains, I had to start taking it again. Then, after another month, I went to a new psychiatrist, and so the fun began. He said that I've never been depressed, that I am bipolar and that it's normal to recognize this disorder only after a very long period of time. He forced me to come off Duloxetine almost cold turkey again, despite my warnings about what I had passed, and he gave me Depakin (it's a combination of Valproic Acid and Sodium Valproate) to stabilize my mood. He tried also with Amisulpride and Abilify, but I stopped them immediatly: the first one facilitated the onset of panic attacks; the second one, well...Let's say it was just awful even after a single ingestion.

 

Fast forward five months, I'm in a bad condition again. Depakin gave me horrendous side effects (dyspepsia above all) so I insisted on being on as low dose as possible (now I'm on 400mg, but I was on 1000mg roughly 2 months ago). Also, some withdrawal effects don't seem to attenuate, and my doc says it's because I'm on "a child dosage" and those are actually the bipolar symptoms kicking in.

 

To say that I'm confused it's an understatement. So I have a lot of question for all the kind people here:

 

- is it really possible that I'm bipolar? To my knowledge, I've never showed behaviours that could lead to this diagnosis before stopping antidepressants (that doesn't mean that I can't be wrong of course, maybe they were "hidden", or mild, or just misinterpreted).

And If I really am, there's a way I could live at least decently without Depakin or other similar drugs?

 

- does it even make sense to reinstate Duloxetine again to reduce the withdrawal effects?

 

- I really want to come off Depakin completely, even if I'm not really sure it's the right thing to do. Do I have to taper it as slowly as an antidepressant? Can I cut the tablets for micro-dosage even if it's the extended release form?

 

 

Thanks in advance to everyone and sorry for the long post! This forum is really a precious source of informations that can hardly be found elsewhere.

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Jemima

Welcome to the forum, Outshined. You'll find lots of gentle, helpful support here. When you're up to it, please put your drug history in the signature area of your profile like so:

 

How to add your drug history to your Signature

 

You most likely are not bipolar. The after-effects of being jerked around on antidepressants are often misdiagnosed as mania by mainstream psychiatrists, the claim being that the antidepressant(s) "unmasked" the bipolar condition. That is nonsense. Antidepressants are extremely strong and stimulating drugs and psychiatry fails to recognize that there is a withdrawal syndrome involved in going off them. I went through a period that might have been considered manic when I got off of Lexapro too fast and many others here have had that experience. True Bipolar is an extremely rare condition, so I doubt you have to be worried about having a lifelong handicap. You don't come across as manic at all.

 

I can't give you any advice on reinstating Duloxetine without knowing how long you've been off of it and how much you were taking, but if you've been off it more than a month going back on is risky. I'm not familiar with Depakine at all, but any drug that prevents seizures or affects mood is probably best tapered slowly. We'll get into the specifics of tapering later, but Depakine is available as a liquid, at least here in the U.S.A.

 

So there is reason for hope. It takes time, courage and some hard work, but antidepressant withdrawal syndrome can be overcome.

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Altostrata

Welcome, Outshined.

 

Bipolar disorder is hugely overdiagnosed. Poorly informed doctors often misinterpret adverse effects of antidepressants as bipolar disorder. It sounds like that is what happened to you.

 

You're about 5 months off Cymbalta, is that correct? How long have you been on Depakin?

 

I can't find any detail about extended-release Depakin, at least in English. Would that be Depakin Retard from Sanofi-Aventis? http://www.catalog.md/drugs/depakine-chrono-retard.html

 

For similar drugs in the US, see Depakene http://www.drugs.com/pro/depakene.html (comes in a liquid) or Depakote http://www.drugs.com/ppa/valproic-acid-and-derivatives-sodium-valproate-divalproex-sodium.html (comes in "sprinkles"):

  • Divalproex ER tablets and valproic acid delayed-release capsules: must be swallowed whole; do not break, crush, or chew.
  • Divalproex sprinkle capsules: May be swallowed whole or sprinkled on a teaspoonful of soft food (eg, applesauce, pudding) and swallowed immediately without chewing.

These topics may give you some ideas about how to taper Depakin http://survivingantidepressants.org/index.php?/topic/300-important-topics-in-the-tapering-forum/

 

We recommend a 10% reduction per month, see http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

 

If you have extended-release tablets, I don't know how they will behave if you cut them up. It might be safer for you to convert to an equivalent dosage in Divalproex Sodium (Depakote) "sprinkles," which would enable you to decrease gradually.

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Outshined

Thanks to all for the kind replies!

 

I can't give you any advice on reinstating Duloxetine without knowing how long you've been off of it and how much you were taking, but if you've been off it more than a month going back on is risky.

Basically I'm 9 months off Duloxetine, though I've reinstated it (30mg) for one month or so from August to September. Now I'm about 4 months off.

 

 

 

You're about 5 months off Cymbalta, is that correct? How long have you been on Depakin?

 

4 months off Cymbalta and 4 months on Depakin. I started taking Depakin as soon as I stopped Duloxetine. Started with 300 mg, then gradually raised to 1000, then back to 800, 500 and now 400. But only because I forced my psychiatrist to cut the dosage, and the reduction from 500 to 400 was made without him knowing it at all.

 

I can't find any detail about extended-release Depakin, at least in English. Would that be Depakin Retard from Sanofi-Aventis? http://www.catalog.md/drugs/depakine-chrono-retard.html

 

That's exactly right. The complete name is "Depakin Chrono", indeed. It's a mixture of Valproic Acid and Sodium Valproate (I don't know if it's the same as divalproex sodium) with extended release, from Sanofi-Aventis

 

If you have extended-release tablets, I don't know how they will behave if you cut them up. It might be safer for you to convert to an equivalent dosage in Divalproex Sodium (Depakote) "sprinkles," which would enable you to decrease gradually.

 

I think I'd have to talk to my General Practitioner (I don't know how the medical system works in the States, but here we basically have a doctor assigned to every family) to get the prescription. There is no way my psychiatrist would let me get it, knowing what I would do :).

Is the dosage completely equivalent? I don't mean the weight of the tablet related to the weight of the "sprinkles", of course :)

 

I've already read everything I could about tapering on that sub-forum, thanks.

 

By the way, I'm having really nasty symptoms lately, that to be honest are really frightening me. Can I talk about them here or in the "Symptoms" section?

 

 

Thanks again!!

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Altostrata

If you want to talk about symptoms generally, join on conversations in the Symptoms forum.

 

If you want advice about your particular situation, post in your Intro topic.

 

What I'm finding (from Wikipedia http://en.wikipedia.org/wiki/Sodium_valproate) is that

In much of Europe, Depakine and Depakine Chrono (tablets) are equivalent to Epilim and Epilim Chrono

http://www.drugs.com/uk/epilim-chrono-spc-3544.html

NICE has advised that generic switching of valproate preparations is not normally recommended due to the clinical implications of possible variations in plasma concentrations.

http://www.drugs.com/uk/epilim-liquid-spc-9823.html

Epilim Liquid/Sodium Valproate 200mg/5ml Liquid

 

....Epilim Liquid may be given twice daily. Epilim Liquid should not be diluted.

 

In patients where adequate control has been achieved Epilim Chrono formulations are interchangeable with other Epilim conventional or prolonged release formulations on an equivalent daily dosage basis.

There are also Epilim 100mg crushable tablets http://www.drugs.com/uk/epilim-100mg-crushable-tablets-spc-9824.html , with the same equivalency to Depakin Chrono.

 

Can you get Epilim liquid or the 100mg crushable tablets? Check the chemical equivalence of Epilim and Depakin with a pharmacist. The liquid will be preferable, it will enable you to taper off with more control.

 

It looks like you can switch from Chrono to the liquid or crushable tablets with twice-a-day dosing totaling the same daily dose.

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Outshined

Thank you so much the precious info Alto.

 

I did a search and there are two forms of Depakin that I could use: the liquid form, and a "granular" form (which should be also with extended release).

 

It should be similar to this one: http://www.netdoctor.co.uk/brain-and-nervous-system/medicines/epilim-chronosphere.html

 

It should also be almost equivalent, regarding dosage.

 

Now the problem is convincing my family doctor...

 

 

 

Anyway, about the symptoms. Things got slowly better since I stopped Duloxetine, but there are a couple of adverse effects that I can't get rid of:

 

- memory, cognition and concentration problems. From what I've read here, they're pretty common. It seems like they got worse since I started taking Depakin though. It's really frustrating because I feel like I'm "dumb". In some cases, I had difficulties remembering people's names, people that I know very well.

 

- obsessive behaviours and thoughts. This is really scary. Sometimes I can't stop doing certain things (like I can't stop surfing the web 'till I find what I was looking for, even if it takes many hours) or I have to be absolutely precise in certain tasks, even if they're trivial (like folding a tablecloth). While I've always been a "perfectionist" through my whole life, I can guarantee to you I've NEVER been compulsive in any shape or form, before stopping antidepressants.

 

- sense of derealization. This is the worst. It feels like sometimes I'm getting out of my mind, like I'm losing control over myself. Like I'm going crazy (sorry if the word seems to harsh, of course I don't want to offend anyone). Erratic thoughts flood in and I can't manage to stop them. This condition is often triggered by the previous ones.

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Altostrata

You may be experiencing a combination of adverse effects from Depakin and withdrawal symptoms from duloxetine.

 

I guess either the granules or liquid might do. You'd have to weigh the granules. I'd feel more comfortable with the liquid, even if I had to take it twice a day, because I could better control the dosage.

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Outshined

Ok, thanks for the tip.

 

Other things that I forgot to mention : a few weeks after stopping Duloxetine, I started having a sharp pain in my lower abdomen area, especially when doing certain movements (e.g. flexing the right hip). After 8 months of various medical examinations, it turned out to be a neuropathy of the ilioinguinal nerve. Maybe it's a coincidence, but still...

 

Also, I'm on antiacids since 18th of January due to a gastritis and a Helicobacter Pylori infection. I've read here that they can impair vitamin B12 absorption and mess with recover from withdrawal.

 

 

By the way, if anyone knows of any scientific paper/study/article about adverse effects of Depakin (especially long term), please feel free to share.

I've read a ton of things about antidepressants from this forum but I didn't find much about mood stabilizers/anticonvulsivants.

I did a search on the Web and I found a lot of anedoctal evidence, but I don't how much they can be reliable. I trust much more the people on this site.

 

This paper is quite interesting though : Comparative cognitive effects of phenobarbital, phenytoin, and valproate in healthy adults

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Altostrata

Did you get an antibiotic for Helicobacter Pylori?

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Outshined

Not yet. I have the medical examination next week.

The gastroenterologist after the endoscopy said that I could have Helicobacter Pylori infection but to be completely sure he had to wait for the histological analysis, that arrived a couple of days ago.

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Outshined

Little update!

 

I managed to get Depakin in the liquid form. Its active ingredient is only Sodium Valproate, while the tablet version is a combination of Sodium Valproate and Valproic Acid. From what I understood, they should be equivalent; for example, the instructions of the extended-release 300mg tablet form say "Sodium Valproate 199,8 mg - Valproic Acid 87,0 mg (equivalent to 300 mg of Sodium Valproate). I guess it's the ENTIRE tablet that has 300 mg...

 

But I've read elsewhere on the web that the various forms are not equivalent : http://www.namihelps.org/assets/PDFs/fact-sheets/Medications/Depakote.pdf

 

Valproic acid is available in many different forms. It is important that you know which form you are taking. It is also important that you not interchange or mix these forms, since they are not always equal in strength. For example, Depakote®500 mg tablets is NOT equal to Depakote®ER 500 mg tablets.

So, well, I'm a little puzzled.

 

Also from what I've read, I should take it 2-4 times daily with food. Is this correct? I'm asking it because the ER tablet form could be taken anytime and in any way.

 

Another note: the "normal" version (i.e. without extended release) it's not indicated for the treatment of the bipolar disorder.

Uh, why? Is it a legal thing or something similar? Because, from what I get, they're basically identical: Sodium Valproate is just the sodium salt of Valproic Acid. It's not really important of course, I just want to be sure that I can taper safely with the liquid form.

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Altostrata

Don't worry about whether it's for bipolar disorder. That's a medico-legal definition.

 

Does this answer your dosing question?

 

http://www.drugs.com/uk/epilim-liquid-spc-9823.html

Epilim Liquid/Sodium Valproate 200mg/5ml Liquid

 

....Epilim Liquid may be given twice daily. Epilim Liquid should not be diluted.

 

In patients where adequate control has been achieved Epilim Chrono formulations are interchangeable with other Epilim conventional or prolonged release formulations on an equivalent daily dosage basis.

 

This table shows the equivalancies of Epilim (sodium valproate) and Epilim Chrono (sodium valproate plus valproic acid) http://pb.rcpsych.org/content/27/12/446/T1.expansion.html

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Outshined

Thank you so much for the info Alto. Yeah I've already read the article that you posted before, but that pdf made me wonder.

 

I guess the problem with the dosage is that the ER form is more "stable", while the basic form could have more fluctuations in valproate plasma levels, so maybe it could require little adjustments.

 

The reality is that I'm just too paranoid because I don't want to mess things up (or feel worse) :), especially considering that these days I'm already very nervous because I intend to "dump" my current psychiatrist, since the trust relationship is irremediably compromised. I can't be honest with him since I know he's going to see everything under the filter of his biased diagnosis disregarding AD withdrawal syndrome completely, and he even pretends to increase the number and the dosage of the drugs, because, in his opinion, the fact that I was feeling better (correlated with a Depakin reduction) a couple of weeks ago was the beginning of a manic episode...

 

So well, I will be without a medical guidance again. I've already changed 5 psychotherapists and I lost the hope to find one of them aware of the brutal problems that prolonged AD use could lead into. To be honest, I don't know if valproate could have the same long term nasty effects, but what I'm sure is that I DON'T want to experiment anymore to the detriment of my health.

 

Damn, sorry for the long rant!

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Altostrata

Yes, sometimes people have a bit of trouble converting from one form to another in any psychiatric drug.

 

If you had a doctor you could trust, you wouldn't have to make these decisions on your own.

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