BPD and Depakote

Written by Dr. Leland Heller

QUESTION:

I was diagnosed 3 years ago as a manic depressive with severe mood swings. Almost two years ago I quit taking all meds due to the fact that; 1. It has taken me forever to REALLY accept that I have this illness, and 2. I felt that the cocktail I was on was too strong and would adversely affect my physical health i.e. liver. Here is what I was taking: Depakote 250 mornings, 500 afternoons, 1250 at bedtime Prozac 20 mg in the morning Trazadone 100 mg at bedtime as needed for sleep

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Two years ago, I had a major depressive overload due to a relationship breakup. The blood level for the Depakote at that time (I admitted myself as an emergency precaution) was 99. I was having all kinds of concentration problems that the DR. said could be from the meds but that I had to keep taking them.

I am now tired of this lifelong struggle with moods, manic swings that are mixed with depression, and the total upheaval of my career life due to the fact that I can't seem to handle stress like I used to (or at least thought I could). I started back on the Trazadone 100mg at bedtime for sleep and 500 mg of Depakote at bedtime as well. Now I am drowsy as hell. I can't seem to get it together in the morning.

Here is my question: Do I really need to be at the high end of the therapeutic scale in order for the Depakote to do its job? From what I read, the Depakote/Trazadone combo might just be what I need to stop the swings as well as the mania.

DR. HELLER'S ANSWER:

It's extremely unusual that some combination cannot be found that is both tolerable and effective. Lithium is an alternative to Depakote. You should look carefully at the BPD diagnosis, because you could have two mood swing disorders, and are only treating one. Trazodone is used in the US mostly for sleep, and sometimes to improve sexual interest in women.

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