[MrAbbott]

Hello, hope you guys are holding up well. It's been a while since my last post, so maybe you've forgotten all about me, let me refresh your memory:


I'm bipolar type I with occasional psychosis and lithium was giving me hypothyroidism, so my pdoc lowered its dose and started me on valproic acid. It was all going pretty well until 3 months ago he increased the valproic's dose and I've recently suffered a syncope... I fainted in the bathroom and hit my head so hard that had to carry staples for a while (my pdoc hasn't admitted this event and valproic acid are connected yet btw...).


Well this is what I wanted to tell you: it looked like my doc had found the perfect medication but now I must start all over again, because both valproic and lithium have downsides that can't be ignored and I don't know what I'm gonna do. I haven't even been able to check if valproic is able to keep psychosis away yet either...


Well, thanks for reading this, please comment if you will. Cheers. D.

[JaneOnceMore]

Welcome back! Sounds like you are on quite the meds-merry-go-round. Hope you get it sorted out. My hypothyroidism is controlled well with Eltroxin. I'm pretty sure valproic acid is Epival, in which case i can barely remember the few months i was on it, i was so sedated. I don't mind, it was a terrible time in my life. I have bipolar II, so i don't know about psychosis control.

Good luck and keep us updated!

[MrAbbott]

... yes it's a merry-go-round and I'd prefer my doctor to have been clearer about it in the first place. Thanks for your answer Jane I'll see how it turns out but been told lithium and valproic are the two main ways to go... what happens to those who can't tolerate either? :O Hmmm. Cheers then, take care ^_^

[Aurelius710]

I'm curious if the lower dose of lithium has helped the hypothyroidism? My experience with lithium is that many of the adverse effects come being on much higher doses for a long period of time. I currently take 450mg twice daily and my lithium levels have never been high enough to cause issues. My PsychNP has been very conscious of insuring that I'm at a therapeutic but safe level with my meds.

I can't speak for valproic acid as I had issues from the get-go (muscle stiffness, too much sedation, etc) and had to stop after a week.

I've been on lamotrigine in addition to lithium and it has been a godsend! It was a heck of a merry-go-round to get to this point of relative stability.

I hope, in whatever form they take, you find the meds that are your godsend.

[JaneOnceMore]

@MrAbbott:

You learned me something! I didn't know the word 'syncope' before. Yay for obscure words!

[MrAbbott]

Originally Posted by Aurelius710

I'm curious if the lower dose of lithium has helped the hypothyroidism? My experience with lithium is that many of the adverse effects come being on much higher doses for a long period of time. I currently take 450mg twice daily and my lithium levels have never been high enough to cause issues.

Hi Aurelius. In my case 400mgx2.5 = 1000mg lithium per day already started to mess my thyroids up. Introducing valproic was all about trying to fix my hypothiroidism... but I still need to find out if it's been worth it... and having a fainting spell hasn't helped to keep my hopes high. I know my doctor will try to convince me to keep taking valproic, it's just that I'm afraid.

[MrAbbott]

Originally Posted by JaneOnceMore

@MrAbbott:

You learned me something! I didn't know the word 'syncope' before. Yay for obscure words!

Haha yes the word in Spanish is very similar, so that's the term I use. I've also learned "fainting spell" which reminds me of witches and wizards, but not the pleasant kind . I was at the mercy of chance and ended up banging my head against a wall and then the ground... not funny business---

[Tart Cherry Jam]

Divalproex Sodium (Oral Route) Side Effects - Mayo Clinic mentions neither fainting nor syncope.

No, Depakote does not protect against psychosis. In some cases, it causes psychosis as a side effect. For protection against psychosis, you need an antipsychotic. I guess in your case it is Invega, but you are still having breakthrough symptoms, which is why I asked on your other thread what other antipsychotics you had tried before deciding to settle for Invega. Invega also has on average more side effects than some other antipsychotics.

Depakote and Lithium act synergistically.

I wonder whether you have tried Levothyroxine for Lithium-induced hypothyroidism.

All antipsychotics can cause orthostatic hypotension. This can cause a syncope. It has happened with me but luckily I just barely missed hitting my head against a glass table as I fell. I believe that out of your three psych drugs, the most likely to have caused a syncope is Invega. But this is not something specific to Invega: all antipsychotics can do that. That is why it is of supreme importance to always be well hydrated. When you fell in the bathroom, was it first thing in the morning?

[MrAbbott]

Originally Posted by Tart Cherry Jam

Divalproex Sodium (Oral Route) Side Effects - Mayo Clinic mentions neither fainting nor syncope.

No, Depakote does not protect against psychosis. In some cases, it causes psychosis as a side effect. For protection against psychosis, you need an antipsychotic. I guess in your case it is Invega, but you are still having breakthrough symptoms, which is why I asked on your other thread what other antipsychotics you had tried before deciding to settle for Invega. Invega also has on average more side effects than some other antipsychotics.

Depakote and Lithium act synergistically.

I wonder whether you have tried Levothyroxine for Lithium-induced hypothyroidism.

All antipsychotics can cause orthostatic hypotension. This can cause a syncope. It has happened with me but luckily I just barely missed hitting my head against a glass table as I fell. I believe that out of your three psych drugs, the most likely to have caused a syncope is Invega. But this is not something specific to Invega: all antipsychotics can do that. That is why it is of supreme importance to always be well hydrated. When you fell in the bathroom, was it first thing in the morning?

Hi Tart, I've tried Seroquel as an antipsychotic, but I threw it in the trash as I felt my mood was going down. Bad move, but after that my pdoc decided to try with invega. Haven't tried with Levothyroxine and hope it's never necessary.


I awoke at 3am to go to the bathroom and then it happened. My doctor has changed my invega pill to the morning to see if that makes any difference.

Thanks for your interesting input, my pdoc has finally considered invega as the possible culprit, but will maintain it (he gives very few info, I didn't know antipsychotics can give syncopes, btw).

[Tart Cherry Jam]

If it happened at 3AM when you got up to go to the bathroom, it was most likely orthostasis (a drop in blood pressure following an abrupt change of position from lying to standing), which can be as bad as to cause syncope.

There are many antipsychotics out there, besides Seroquel and Invega. If Invega works for you and in particular if it does not cause lactation in you, it might be the right med for you. But if you are willing to try other things and the pdoc is willing to experiment, there are many others now on the market.

The pdoc should have told you not to change position abruptly anymore. When you wake up, sit on the bed for a bit and then only get up to a standing position.

[MrAbbott]

Originally Posted by Tart Cherry Jam

If it happened at 3AM when you got up to go to the bathroom, it was most likely orthostasis (a drop in blood pressure following an abrupt change of position from lying to standing), which can be as bad as to cause syncope.

There are many antipsychotics out there, besides Seroquel and Invega. If Invega works for you and in particular if it does not cause lactation in you, it might be the right med for you. But if you are willing to try other things and the pdoc is willing to experiment, there are many others now on the market.

The pdoc should have told you not to change position abruptly anymore. When you wake up, sit on the bed for a bit and then only get up to a standing position.

My doctor, as many doctors here, is quite traditional in the sense that lithium is his go to med. i've had crisis when on lithium that he couldn't explain so that's why we introduced valproic. I truly miss a doctor who would hand out more information to the patient: he has never mentioned things like weight gain or now, he has not instructed me about changing position, etc. Even now, a month after the syncope, my left side of the body feels some pain and I'm afraid of fainting again, but he seems not to know if it'll ever happen again, so all I can do is live life as normal as possible. Being sick is not a pleasant business. Thanks for your help. Today the sun is scorching over here, I'll lay low.