Depakene

US Brand Name: Depakene

Other Brand Names: Convulex (UK, South Africa [but not the syrup!], Belgium, Taiwan), Depakin (Italy), Depakine (Taiwan), Epilim (Malaysia), Leptilan (Portugal), Orfiril (Germany), Valporal (Israel), Valprosid (Mexico)Generic Name: valproic acid 

Other Forms: Epiject – intravenous form available in Canada, syrup (Note that Convulex syrup is valproate sodium and there’s a Depacon syrup.  Confused yet?)

FDA Approved Uses: Monotherapy (used by itself) and adjunctive treatment (i.e. you must use another drug along with it) for simple and complex absence seizures.  Simple absence seizures are when you just go away for a little while, and are the kind that I would have.  Complex absence seizures are more involved forms of absence seizures and can include anything up to a kind of sleepwalking that can last for hours.  I’m convinced that a large number of the abduction phenomena that occur are not the responsibility of extraterrestrial aliens but rather are due to complex absence seizures.

That’s it.

Everything else is an off-label application.  What, you thought you were getting generic Depakote that was approved for other types of seizures, bipolar disorder and migraines?  Sorry, but you and/or your doctor fell victim to the whole Depakene/Depakote/Depacon confusion.

Off-Label Uses: Treatment for types of Epilepsy not listed (e.g. tonic-clonic seizures, and other seizure types going back quite some time, and the intravenous form can be used for the dread status epilepticus.), Bipolar Disorder (valproic acid is not officially aproved to treat bipolar disorder), Schizoaffective Disorder, Social Anxiety Disorder,   Alcohol & other Drug Dependencies.  There are probably a lot more, but most of the studies published on Pub Med refer to the newer Depakote or Depacon forms, or just the generic valproate.  While many doctors,  researchers, and even Pub Med may be comfortable with treating all valproates the same, I’m not.  The pharmacodynamics (how they work in your brains) may be identical, but the pharmacokinetics (how they get from your mouth to your brain) can vary greatly from person to person.

Pros: Proven to be effective for wide spectrum of epileptic disorders.  It’s been around for so long that the long-term effects are well known and well documented. If you can get past the initial side effects and get used to a valproate medication, you don’t have to worry about anything biting your ass in the long run.

Cons: The side effects suck donkey dong! The valproates are amongst the harshest meds to take. Everyone hates them so much that they’ve given the entire class of anticonvulsants a bad name.

Typical Side Effects: The usual for anticonvulsants plus a special set for valproates: instant old age. You’ll get fat, bald, tired, confused, uninterested in sex, unable to hold your liquor and everything will give you heartburn and/or the runs.

Not So Common Side Effects: Acne.  You can be old with zits.  It’ll also mess with your hair besides thinning, like changing its body.

These may or may not happen to you don’t, so don’t be surprised one way or the other.

Freaky Rare Side Effects: Fanconi’s Syndrome – near constant pissing, and breast enlargement.  I’m sure there’s a market for that on the Internet somewhere.  I had to go back to a 1999 edition of the PDR for this, because later editions list Depakote’s adverse effects.

Interesting Stuff Your Doctor Probably Won’t Tell You: No, you’re not taking generic Depakote (divalproex sodium).  I don’t care what anyone said, Depakote (divalproex sodium) isn’t available as a generic yet on the US market.

You’re more likely to have GI issues.  It states in the older PI sheets for Depakene (valproic acid) that if you have GI problems you’d be better off switching to Depakote.  Now all the adverse effects for Depakene (valproic acid) are those for Depakote, and there is not advice to switch.  Taking Depakene (valproic acid) with food helps reduce a lot of the gastrointestinal problems.  Abbott states in the PI sheet that absorption may vary with formulation (i.e. Depakote (divalproex sodium) vs. Depakene (valproic acid) or Depacon (valproate sodium)) or if taken with food or not, but that it shouldn’t really matter. This is opposed to the Topamax sprinkles (topiramate), which were designed for caregivers to slip to people unable or unwilling to take pills. That’s not so blatant on the PI sheet Ortho-McNeil publishes online now, but one I have shows you how to open up the capsule and mix it into food so it’s nice and hidden and somebody doesn’t know they’re taking their medicine.

Depakene (valproic acid) interacts with aspirin. Aspirin prevents you from metabolizing Depakene (valproic acid) properly, so you’re better off with ibuprofen.

Your doctor had better damn well be telling you about the regular blood work you need, to check your valproate levels and to make sure your liver is functioning normally.

Dosage: Depakene (valproic acid), like lithium, is all about blood levels.  For epilepsy – remember this isn’t generic Depakote (divalproex sodium) and is approved only for absence seizures –  the initial dosage is based on your weight. Why the hell not? Personally I think that’s better than just throwing 750mg a day at someone and ramping up drastically. While weight isn’t always a good factor at determining how burly your liver is (I could drink bigger men than I under the table), until tests of liver enzyme functions are more widely available, it’s as good a guess as any. So you start at 10 to 15mg/kg/day. So for that 150-pound person that’s between 750 and 1,000mg a day.  It comes in 250mg capsules, so you dose based upon your dosage up to three times a day.

Anyway, after that you can up the dosage by 5-10mg/kg/day until the seizures abate or you max out at 60mg/kg/day or you reach the sweet spot of blood levels between 50 & 100.

For everything else, it’s up to your doctor and whatever studies your doctor is following.  Really.  It’s all off label.

In theory treatment for bipolar disorder and migraines would follow those of Depakote, as these meds are presumably interchangeable.

Days to Reach a Steady State: Depakene’s non-linear.  Anyway, that means you can’t pin down a hard number on it. I haven’t found a number for it in any study.

When you’re fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you’ll have fewer valleys after this point. In theory anyway.

How Long it Takes to Work: In theory you should start feeling results once you’re in the therapeutic range of your blood levels. So for epilepsy that’s generally in the neighborhood of 50-100, and for bipolar it’s a wider range of 40-150. Getting to that blood level is between you and your liver. Once there it’s up to your brain if it’s going to respond to a valproate or not. So unlike most anticonvulsants where you feel something in a matter of days, or there’s a definite dosage where we can write, “here is where you should notice effect or not,” it’s just not like that with the valproates. So once you’re there, here’s a study with PET scans indicating 2-6 weeks to start feeling something.

Half-Life & Average Time to Clear Out of Your System: 6-16 hours. You should thus step down the dosage by however much you increased it (keep good records about that!) a day every two to three days.

Like any anticonvulsant, if you’ve been taking Depakene (valproic acid) for more than a couple months and you’ve reached the therapeutic blood levels, you just can’t stop cold turkey if you’re not at the therapeutic dosage for another anticonvulsant that is known to work for you, otherwise you risk partial onset or absence seizures to tonic-clonic grand mals, even if you’ve never had a seizure disorder before!  The risk is worse if you’re taking a lithium variant, and/or any antidepressant, especially Wellbutrin. Anyone with a history of a seizure disorder who needs to stop taking an anticonvulsant cold turkey needs to be discussing that with two neurologists and not getting your information from some stupid web site. Get off your computer and start making appointments!

If you’ve worked your way up to a particular dosage, it’s usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them.
Comments: Be sure to read the sections on anticonvulsants and valproate drugs if you haven’t done so already.
The original member of the valproate family, valproic acid was discovered by a happy accident in 1962 when Pierre Eyrnard found that the solvent seemed to be the key component instead of the other anticonvulsants being investigated on rats. In 1963 it was being tried on humans for a variety of generalized epilepsies. By 1967 it was approved for usage in treating epilepsy in France. It has been in use as an anticonvulsant in the US since 1983.

And it is not generic Depakote.

People forced to switch from Depakote to valproic acid by HMOs, insurance plans, or getting dumped into government health services, they frequently report more, more intense or different side effects. Or that it really isn’t as effective at the same dosage. If that happened to you, it’s not in your head, it’s in your stomach or liver. It’s real. In the 53rd edition of the PDR Abbott recommended switching from Depakene to Depakote if the side effects were too harsh.

Now everyone gets the same PI sheet for all three valproates. That is just crazy. That’s why I’ve included links to the online PI sheets from New Zealand, South Africa, the UK

It’s difficult to get studies out of Pub Med because when you enter any valproate it returns results for all three, plus the generic “valproate.” And most of the articles published on valproic acid are older and not online. But there are a few. We can see that it helps for ultrarapid cycling. Whoopee. But except for the studies in the off label uses above, I can’t find anything online for valproic acid. There’s a ton of stuff for Depacon (popular around the world) and Depakote (divalproex sodium), but not poor old-fashioned valproic acid.

So you just have to take everyone’s word that it works just like the other two.

I’m not making you that promise, they are.

If you were forced to switch by someone else and you don’t suffer from absence seizures, you could call them on the fact that valproic acid is not FDA-approved to treat anything except absence seizures and you demand the FDA-approved med. HMOs, insurance companies and government agencies respond to things like FDA approval. However that tactic will likely make it next to impossible for you to get any off-label med if the Depakote doesn’t do it for you. You’ll have to balance your strategy against your side effects.

My advice is to get the real thing, Depakote (divalproex sodium) or whatever they call valproate sodium in your part of the world.

As for dealing with those awful side effects:
Depakene has been tested with every known antacid, because, you know, Depakene messes with your stomach so much. At least you can take antacids and Depakene together. Just don’t use Alka-Seltzer, as that has aspirin, and you don’t want to mix aspirin and valproates.
I had hoped to provide all y’all with something to give you some hope on the hair-loss front. Sorry. Nutritional supplements usually don’t do squat for hair loss. There was one letter published in an obscure journal which may state just the opposite when it comes to Depakote, but it’s not online so I don’t have a clue. Here’s the cite if you want to dig it up yourself.
For the lethargy, like all anticonvulsants the only safe thing to counter it seems to be Provigil (modafinil). Everything else is just too likely to trigger either mania or seizures.
Beta blockers like Inderal have been used to counter the tremors associated with lithium. I haven’t seen a reference to their being used with valproates.
The weight gain is going to suck. Diet and exercise are going to do only so much, and everyone is going to give you shit about how lazy and weak-willed you are for gaining weight when it’s the pills that are causing the weight gain! Yet every pill out there that can counter that weight gain is most likely a no-no. Diet pills that work will trigger seizures and/or manias. Anticonvulsants with weight loss as a side effect such as Topamax (topiramate) or Zonegran (zonisamide) may be inappropriate for you and make you worse, not better. There are some wacky alternatives thought that may work out. They are a bit strange, and will require careful consultation with your doctor. They are also unlikely to be covered by any form of insurance.
The anti-Alzheimer’s medications Exelon (rivastigmaine tartrate) and Aricept (donepezil hydrochloride). You need take one or the other. These are a two-fer, as they help deal with the memory issues and fuzzy-headedness that come with anticonvulsants. They also frequently cause weight loss. Like Zonegran (zonisamide) this happens more often for women than men. Go figure.
Symmetrel is an antiviral and anti-Parinkson’s medication. There was one small study done on its effects reversing the weight gain caused by Zyprexa (olanzapine). While it may not help with any cognitive issues, at least it has a study backing it up that it doesn’t fuck up the benefits of a psychiatric med. I’ll keep all y’all posted if I find out any more about this med and the whole weight issue in general on a separate article about weight and meds.
There’s not much that I know of that you can do for your liver. Oh sure, there’s that wonderful milk thistle (silymarin) and the amino acid NAC. There are just two big problems with those:
Like any supplements you don’t know if you’re getting the real thing or not.
When you do get the real thing, they work. They work too well. Milk thistle extract has been used to save people who have eaten the wrong type of amanita mushroom. So what does that mean to someone taking a med like Depakene that is heavily processed by your liver? It means that the milk thistle and NAC flush the Depakene out of your liver before it gets metabolized! So, yeah, your liver gets cleaned out all right, and your Depakene doesn’t work! There has been one double-blind study involving silymarin and Haldol [1] indicating that, yeah, the milk thistle helped prevent liver toxicity, but at what cost to the efficacy of the psychiatric meds? The doctor who is treating me for environmental sensitivities who had me taking the milk thistle and NAC advised me to stop when I began a course of psychiatric meds, otherwise I’d just have to take more meds, and that would be counterproductive.

 

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