[MrAbbott]

Hi, I hope you're ok. I live with my elderly mother so it's actually a big help to share my thoughts with you or I'll be worried to death. Thank you in advance for your help. My doctor has decided to bet stronger on valproic and I have two questions for you:

1. I know mileage may vary, but anybody here thinks I shouldn't feel overwhelmed by the severity of possible side-effects valproic acid brings on the table? I mean, has it worked for you? Can you keep taking it for many years with no trouble?

2. I feel a bit of hypomania would make my life more bearable, but all I feel lately is tiredness. It may be due to lithium and valproic and I have also gained some weight. My last question: can a bipolar person with psychosis be treated on anti-psychotics alone? My doctor has never given me this option.

My pdoc will monitor me closer these days but told me nothing about the reason. When I asked him about it he just replied my message with "don't worry, all shall be fine". I'd like to have more information but he's one of the best doctors that has visited me, so I guess I need to go with it...


Thank you for reading this . Peace. D.

PS. I have just updated the new doses, I start treatment tomorrow.

[Nammu]

It’s been decades since I was on either lithium or valproic acid. I can’t recall specifics. But I assume it didn’t work for me for whatever reason.

I’m on an AP alone currently. Haven’t had psychosis for years. But there are side effects. Metabolism syndrome and weight gain. But the stability I have is worth it.

[MrAbbott]

Originally Posted by Nammu

It’s been decades since I was on either lithium or valproic acid. I can’t recall specifics. But I assume it didn’t work for me for whatever reason.

I’m on an AP alone currently. Haven’t had psychosis for years. But there are side effects. Metabolism syndrome and weight gain. But the stability I have is worth it.

Hi Nammu, your input is always appreciated. I read on your profile you're bipolar as well... being on AP only would be my dream, but my doc makes me feel like that is unthinkable, that bipolar disorder and mood stabilizers must go hand in hand. What is metabolism syndrome? Is it hard on you? Thanks.

[HALLIEBETH87]

I’m
On an antidepressant, anti
Anxiety and an
Antipsychotic. Been doing ok
Myself

[Nammu]

Metabolic syndrome is a bunch of stuff( high blood pressure , high cholesterol extra weight) that together increase your risk of heart attack and stroke. If I didn’t enjoy stability so much I’d quit it in a nanosecond

[Crazy Hitch]

I’m sure your pdoc has weighed up the pros and cons of these meds and decided there’s more benefit for you if you take them.

I put on a lot of weight with it so I was only on it for a month or two but it did stop the mania, along with an AP.

I know bipolar people who are only on AP but I’m always given a mood stabiliser too by my pdoc. It’s what he recommends. I’m currently on lithium. I think I prefer lamotragine though.

[Victoria'smom]

I'm on an antipsychotic and antidepressant only. Most stable I have been. A little bit low but stable. I have no motivation though. I have schizoaffective which is schizophrenia and bipolar together.

[MuddyBoots]

I was on Valproic acid before and couldn't tolerate it either. Too sleepy and weight gain (although I'm very active and have an eating disorder so I really really can't tolerate either of these side effects). It worked well at controlling my mania though. Not so much the psychosis, but like Miguel'smom I have schizoaffective so my psychosis is separate from my mania/depression.

I've done well on just an antipsychotic alone (clozapine). Right now I'm on two antipsychotics and two mood stabilizers though because clozapine requires a lot of blood work and the system here just isn't adequate enough to deal with what that entails (and it causes massive weight gain and a lot of sedation).

If you've been on the valproic acid for more than a month or two and the side effects are still bothering you and you haven't gotten any benefit from it, I would say it's not worth it. But that's just me.

[MrAbbott]

Originally Posted by MuddyBoots

I've done well on just an antipsychotic alone (clozapine). Right now I'm on two antipsychotics and two mood stabilizers though because clozapine requires a lot of blood work and the system here just isn't adequate enough to deal with what that entails (and it causes massive weight gain and a lot of sedation).

If you've been on the valproic acid for more than a month or two and the side effects are still bothering you and you haven't gotten any benefit from it, I would say it's not worth it. But that's just me.

I'm taking both lithium and valproic, I feel tired, but now my pdoc has raised valproic and lowered lithium. I don't know if mood stabilizers can do something against psychosis, but lithium in the past hasn't been able to stop it. Invega is the only antipsychotic I'm taking and wasn't able to stop it either. My longest stability period is 1 year. I guess I need to wait for valproic and its effects but I'd wish to be on AP only. Thanks.

[Soupe du jour]

By the time I was put on the combo of Depakote ER (over 1,000 mg) and Invega (forget dose) I had dealt with what seemed years of hypomanic and full-blown manic episodes (often turning mixed and psychotic). That combination was the first to totally stop it all, like a runaway train hitting a brick wall. Unfortunately, with that I experienced one of the worst depressions of my life. I gained about 30 lbs in six months, developed high cholesterol, high triglycerides, and pre-diabetes. From Invega, I also developed hyperprolactinemia, a condition I had also had from Invega's cousin medication, Risperdal. A little later down the line, an MRI showed a pituitary microadenoma (tumor). The endocrinologist said there was no relation, yet research showed that Risperdal had caused it in many people in the past. That was the final straw. After needing ECT to lift my depression, I demanded a medication overhaul. The IOP psychiatrist offered one.

After going off of the Depakote-Incega combo onto a more weight friendly mix (Lithium, Lamictal, and Geodon...and later also Thiothixine), I was able to diet and lost 40 lbs in six months. I also started experiencing a slowly developing mania, but I looked and felt like a million bucks, but nearly landed in the hospital a couple times, and had many other new and odd neuro-psych issues, necessitating the addition of Tegretol XR. Then my moods sort of fell again. The good news in that change, besides the weight loss, was normalization of my bloodwork, the fading away of hyperprolactinemia, and even the disappearance of the pituitary tumor. Of course Lithium side effects came back with a vengence and I eventually developed a nasty case of akathisia from Geodon.

An overhaul after the above, left me with most of my current cocktail. Honestly, I've been the most stable on this than in my adult life. Though Seroquel(s) have their metabolic effects, they are milder than others I've been on. Also, Seroquel does not cause me akathisia or other EPS, nor hyperprolactinemia or pituitary tumor. For that I am grateful! It's the best of all of the medication evils, for me.

[MrAbbott]

Originally Posted by Soupe du jour

An overhaul after the above, left me with most of my current cocktail. Honestly, I've been the most stable on this than in my adult life. Though Seroquel(s) have their metabolic effects, they are milder than others I've been on. Also, Seroquel does not cause me akathisia or other EPS, nor hyperprolactinemia or pituitary tumor. For that I am grateful! It's the best of all of the medication evils, for me.

Thanks Soupe, you've truly gotten to know the road and its ups and downs. Me, well, my doctor keeps me in the dark, so I was not aware things can get so complicated. I'll try asking for Seroquel next time I see him. I told him about people being treated on AP only and his answer was a plain NO: it's either valproic or lithium for me along with the AP. Is ignorance bliss? Should I trust my doctor and forget about anything else? To be continued...

[Nammu]

APs come with serious side effects. If the mood stabilizers work you are much better off with just them. I think your doctor is being cautious and careful. That’s good. But perhaps you can tell him you feel he is keeping you in the dark and that makes you distrustful of his methods?

[MrAbbott]

Originally Posted by Nammu

APs come with serious side effects. If the mood stabilizers work you are much better off with just them. I think your doctor is being cautious and careful. That’s good. But perhaps you can tell him you feel he is keeping you in the dark and that makes you distrustful of his methods?

He holds an important position at an important Hospital, but I see him in private practice. It's easy to talk to him, but I see that he filters my questions and sometimes only gives very short answers... he hates to explain himself, eg. he has raised my valproic acid but has not mentioned possible side effects: liver/pancreas damage, suicidal thoughts, weight gain, metabolic function, etc. He has failed to explain my situation to my mother in a clear way and that's also, to my view, a big mistake. But he's got a reputation and that's why we're sticking with him. Thanks Nammu.

[Tart Cherry Jam]

I do not think that it is a fair statement that as a class, mood stabilizers have fewer/milder side effects than antipsychotics. The only mood stabilizer with a relatively benign side effects profile is Lamotrigine and it will not do a thing for psychosis. All the others have very serious side effects. A better comparison is to see on an individual basis what each drug (not each class of drugs) produces in you and go from there.

MrAbbott, it is possible for many people to treat bipolar with antipsychotics alone. For some people it may mean taking two antipsychotics. For some it may mean just one, called monotherapy. In terms of FDA approval in the US, Zyprexa is FDA approved as a monotherapy for bipolar and is extremely effective but has a horrible metabolic syndrome side effect. Then there are antipsychotics that are not (yet) FDA approved as bipolar monotherapy but are used as such off label (outside of the official approval). From a Medline (PubMed) search:

Olanzapine, risperidone and quetiapine have been shown to be effective for manic episodes both as monotherapy and in combination with other agents such as lithium and divalproex. Divalproex is valproic acid. Since Invega is a newer cousin of Risperidone, I am pretty sure it can be effective as a monotherapy but you need to give it a try to figure out if this is true.
for you.

I could not tolerate valproic acid because of hand tremor and falling platelets. I also gained a whole lot of weight on it. I will not go back on it. I am stable on antipsychotic Latuda with a small dose of antipsychotic Seroquel taken strictly for sleep. I am not taking mood stabilizers or antidepressants. Antipsychotics fully fix it for me.

Your doctor might be going at it strictly by the book, believing that antipsychotics have to be prescribed only in combo with lithium or valproic acid or both. I especially think so because you implied that your doctor is very traditional and has a bias in favor of lithium. I think you should tell him straight up that you want to find a solution where you are on an antipsychotic monotherapy. Use this term: monotherapy. Tell him that you prefer to avoid lithium and valproic acid altogether.

How is your bloodwork? Both lithium and valproic acid therapy have to be accompanied by regular blood tests.

[Tart Cherry Jam]

quetiapine and Seroquel are the same thing

[MrAbbott]

Originally Posted by Tart Cherry Jam

I do not think that it is a fair statement that as a class, mood stabilizers have fewer/milder side effects than antipsychotics. The only mood stabilizer with a relatively benign side effects profile is Lamotrigine and it will not do a thing for psychosis. All the others have very serious side effects. A better comparison is to see on an individual basis what each drug (not each class of drugs) produces in you and go from there.

MrAbbott, it is possible for many people to treat bipolar with antipsychotics alone. For some people it may mean taking two antipsychotics. For some it may mean just one, called monotherapy. In terms of FDA approval in the US, Zyprexa is FDA approved as a monotherapy for bipolar and is extremely effective but has a horrible metabolic syndrome side effect. Then there are antipsychotics that are not (yet) FDA approved as bipolar monotherapy but are used as such off label (outside of the official approval). From a Medline (PubMed) search:

Olanzapine, risperidone and quetiapine have been shown to be effective for manic episodes both as monotherapy and in combination with other agents such as lithium and divalproex. Divalproex is valproic acid. Since Invega is a newer cousin of Risperidone, I am pretty sure it can be effective as a monotherapy but you need to give it a try to figure out if this is true.
for you.

How is your bloodwork? Both lithium and valproic acid therapy have to be accompanied by regular blood tests.

Thank you for all this info, Tart. I've actually looked for AP monotherapy but found so little info I have nothing to show my pdoc, I'll keep at it. I guess that if I end up in psych ward, they'll also pump either lithium or valproic into my system without checking my preferences, they are like that. I'll try speaking with my doc, or maybe waiting a year to see if valproic is able to stop mania and psychosis much better for me than lithium has had. My limit is 1 year, then I go psychotic.

My bloodwork is not worrying at the moment, the thyroid gland was the most affected, starting with hypothyroidism, but slowly changing to valproichas corrected that. I take omega 3 supplements and my cholesterol has improved but it could be better.

Thanks so much for all of this. I like to know stuff and be able to choose. Stay well.

[HALLIEBETH87]

I take a newer antipsychotic called lybalvi which is zyprexa and a an opioid antagonist which helps fight weight gain. I stopped taking my lamictal of 15 years and am doing much better!!!

[Tart Cherry Jam]

In terms of what they will do if you end up in a hospital, it is not necessarily that they will pump you with lithium or valproic acid. Antipsychoticd and especially Zyprexa have been shown to act more quickly than Lithium to bring one down from a manic episode, so if you end up in a hospital with mania, they are likely to go with antipsychoticd. And if you end up in a hospital with psychosis, they are even more likely to give you antipsychotics.