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What is Depakote?

Depakote (Divalproex sodium), marketed by Abbot Laboratories, is a prescription medication that has been proven effective in the treatment of manic episodes associated with bipolar disorder, also known as manic depression.

What is bipolar disorder?

Bipolar disorder (manic depression) is a neurobiological brain disorder (mental illness) characterized by cyclic mood swings of extreme highs called mania and intense lows known as depression. Bipolar disorder affects more than two million Americans each year, but patients with this disorder can lead fulfilling lives when they receive proper treatment. (Unfortunately, some two-thirds of those afflicted don't receive treatment.)

Medication is an essential part of successful treatment for bipolar disorder, and Depakote is the newest medication approved to treat mania. With the proper dosage, Depakote can reduce manic symptoms, shorten hospitalization, help prevent future manic episodes, and make it possible for an individual to live productively in the community.

When was Depakote introduced to the U.S.?

Depakote has been marketed in the United States since 1983. Until it was approved for use in treating manic depression on June 1, 1995, it was used exclusively in the treatment of epilepsy. This new use of Depakote for the manic episodes of bipolar disorder is a breakthrough in medicine because it is the first medication approved for the symptoms of mania in 25 years.

What is the standard dose of Depakote?

Depakote is available in three tablet strengths, which are administered orally. The recommended initial dose is 750 mg daily taken in divided doses. (The starting dose should be reduced in elderly patients.) Dosages usually begin low and may be increased by the doctor until the patient reaches the point where the lowest therapeutic dose produces the desired clinical effect.

Is there anyone that shouldn't take Depakote?

Depakote should not be given to patients with liver disease of significant liver dysfunction to avoid liver failure. Pregnant women should not take Depakote because of the possible harm it can cause the fetus.

Caution should be taken when Depakote is administered with other medications, including aspirin. Patients must be sure to report all other medications -- prescribed and over-the-counter -- that they are taking to the doctor prescribing Depakote. Depakote should also be given with caution to nursing mothers.

What are the side effects of Depakote?

There are significant risks for pregnant patients that should be discussed with the doctor in each case. If you are already pregnant and on Depakote, do not discontinue it abruptly. Call you doctor to discuss the situation.

Liver problems, which can be severe, may develop on Depakote, especially in the first six months of treatment. Problems with white blood cell count and blood platelets, which can also be severe, may also develop on this medication. Blood tests to monitor liver function and blood cells are an important part of treatment with Depakote, and they serve to make this treatment acceptably safe.

Other common side effects are nausea, drowsiness, and dizziness; but for some patients these conditions lessen or go away over time. Because Depakote may cause drowsiness, patients receiving this medication should not engage in hazardous activities or operate motor vehicles while undergoing treatment until the drowsiness subsides. Some adverse effects on skin and hair may also occur, including rash, hair loss, and itching.

Patients taking stronger doses of Depakote may experience more side effects, so it is important to weigh the benefits of a higher dose against the possibility of greater adverse reactions to the drug.

How long does it take to work, and should Depakote be taken for long periods of time?

In clinical studies, patients have been found to respond to the effects of Depakote after just ten days of treatment. In these studies Depakote was found to be safe in treating a sample of 360 patients for more than three months. However, since Depakote is new on the market for the treatment of mania in bipolar disorder, studies are limited and safety and effectiveness in longer trials have not yet been established. As with any medication, physicians who prescribe Depakote for extended periods of time should continually reevaluate the patient and the drug's overall short- and long-term effects.

What are the advantages of Depakote?

Depakote is a major advance in the treatment of manic episodes associated with bipolar disorder. It is an effective and well-tolerated treatment that offers new hope for patients. There are a number of anti-depressant medications available for treating the depressive episodes of manic depression, but there are only two approved by the FDA for treating mania: lithium and Depakote. The newest of these is Depakote, which has a promising future in the treatment of manic depression.

Reviewed by Elliot Gershon, M.D., chief, clinical Neurogenetics Branch, National Institute of mental Health 11/95