Depakote for Mental Health: Uses, Side Effects, and Stopping Safely
Depakote (or Valproate) is not a newcomer to the mental health scene. In fact, it’s been part of neurological care for decades. According to the stats, Valproate was prescribed over 3 million times in the USA in 2021.¹ It’s one of the most effective epilepsy medications on the market and is helpful in treating Bipolar Disorder and migraines, too.²
Generally speaking, Valproate is a mood stabilizer. It’s similar to Lamictal and Tegretol but works differently. It’s considered the oldest anti-epileptic drug as it was synthesized in 1882 and reached the US market in 1978. Since then, it’s become one of the more established mood stabilizers, and is known to reduce the intensity of manic episodes while providing more consistent emotional regulation.
If you or someone you care about has been prescribed Depakote, you’re bound to have questions about what to expect. This page walks through:
- What Depakote is used for
- How long Depakote takes to work and signs it’s working
- Side effects of Valproate
- Depakote dosages
- How to stop taking Depakote safely
- Signs of Depakote withdrawal
- A brief look at how Depakote and Lamictal stack up
What Is Depakote Used For?
Depakote is prescribed for different reasons. It’s commonly used to manage mood symptoms, particularly in bipolar disorder, but that’s not all. It’s also a treatment for certain seizure disorders (epilepsy). In some cases, doctors use it to help reduce how often migraines happen.
Originally, Depakote wasn’t part of psychiatric care. It was first used to treat epilepsy, and that’s still one of its main uses today.³ Over time it became clear that the same calming effect it had on the brain’s activity could help people with mood disorders too, which is why it was investigated as a potential bipolar disorder treatment.
Depakote for Bipolar Disorder
Doctors often prescribe Depakote for bipolar disorder. It helps tone down the brain’s overstimulation, which can ease the intensity of manic episodes.⁴ Some people take it during a period of acute symptoms. Others stay on it to help prevent episodes from returning.
However, it isn’t always the first medication prescribed. Nevertheless, when someone can’t tolerate lithium, or needs a different approach, Depakote is sometimes the alternative doctors turn to.
Other Uses of Depakote
While doctors regularly prescribe Depakote for mood stabilization, there are other scenarios where it might be a good fit. Depakote is still widely used to treat epilepsy. It works by reducing the electrical activity in the brain that can lead to seizures. It doesn’t work for every type of epilepsy, but for certain patterns, it can be effective.
As we also alluded to, some people also take it to prevent migraines.⁵ This usually happens when the headaches are severe or frequent and haven’t responded to other treatments. While it’s not typically the first option, it’s one of several that might be considered when others haven’t helped.
How Long Does Depakote Take to Work?
Everyone is different, so it’s hard to pinpoint exactly how long it will take for a mood stabilizer to work. That said, most people who take Depakote notice that it works within one to two weeks of taking it.⁶
Depakote tends to take this long to start working because it needs time to build up in your system and begin calming the overactive electrical activity in the brain. It doesn’t act instantly like a painkiller might. Instead, your brain gradually adjusts to the medication, and that process takes a little time. Some people start noticing subtle changes within the first week, but for others, it might take a bit longer to feel the full effect.
Signs Depakote is Working
So, you won’t see instant dramatic signs Depakote is working. Changes happen gradually when Depakote starts working. When Depakote is working well, you should feel stabilized and leveled out. You’ll notice your moods are more balanced and intense emotional swings start to ease off. If you’ve been experiencing mania, your racing thoughts will be less rapid and energy may feel more manageable. Most people experience a more neutral baseline for their mood, instead of experiencing deep depression or severe mania.
Depakote Side Effects
Depakote can be helpful for mood symptoms, seizures, and migraines, but like many long-term medications, it can also affect other parts of the body. Some Depakote side effects show up early. Others take longer and may not be noticeable without regular check-ins or lab work. Knowing what to watch for can help you stay ahead of anything that needs attention.
Depakote and Liver Function
Your mental health care provider may want to discuss Depakote and liver function side effects with you before treatment. Depakote is processed through the liver. For a small number of people, this can put extra strain on how the liver works. If enzyme levels start to climb, it’s often a sign the liver is working too hard to break the medication down.⁷ You won’t feel this happening, which is why mental health treatment teams usually recommend blood tests during the first few months. These labs help catch changes early, before the Depakote side effects turn into something more serious.
Depakote and Weight Gain
Depakote and weight gain can be a sensitive subject for many people taking Depakote. Weight gain is one of the more common side effects, especially if the medication is taken over a longer stretch of time.⁸ It can be related to increased appetite, changes in metabolism, or fluid retention. It’s not guaranteed, and it doesn’t happen to everyone, but it’s something mental health treatment teams keep an eye on during follow-up visits.
Long-Term Effects of Depakote
When Depakote is used for many months or years, it can affect more than just brain chemistry. When it comes to the long-term effects of Depakote, it may shift hormone levels, particularly in younger people. Some notice changes in energy or focus. Bone density may also be affected, though this tends to happen gradually. These risks are the reason most mental health care providers recommend routine check-ins, especially for teens and young adults.
Depakote and Pregnancy Risks
If you’re pregnant or hoping to fall pregnant, Depakote and pregnancy risks should be discussed with your mental health care provider. Depakote is known to increase the risk of birth defects if taken during pregnancy.⁹ The highest risk is in the first trimester when the brain and spinal cord are forming. Because of this, it’s not usually prescribed to people who are pregnant or planning to be. If there’s a chance of pregnancy during treatment, providers usually go over safer alternatives or recommend using birth control while on the medication.
Typical Depakote Dosage Guide
Depakote is available in a few different forms, and the dose depends on why it’s being prescribed. The most common types include delayed-release tablets, sprinkle capsules, and extended-release tablets. Your personalized Depakote dosage guide may vary based on age, body weight, and how someone responds in the first few weeks of treatment.
Starting Doses vs. Loading Doses
A starting dose is the amount a person takes when first beginning the medication. This isn’t always the same as a loading dose. In some cases – especially when treating acute mania – a mental health care provider may use a higher loading dose to get symptoms under control more quickly. Most people begin with a standard starting dose, which is adjusted gradually over time based on side effects, response, and lab results.
Common Starting Doses by Condition and Form
Delayed-release tablets (available in 125 mg, 250 mg, and 500 mg strengths) are typically prescribed at:¹⁰
- 750 mg per day for manic episodes linked to bipolar disorder
- 10 to 15 mg per kilogram of body weight per day for seizures
- 250 mg once daily for migraine prevention
Sprinkle capsules (125 mg) are usually used for seizure treatment and are also started at:
- 10 to 15 mg per kilogram of body weight per day
Extended-release tablets (250 mg and 500 mg) are often prescribed as:
- 25 mg per kilogram per day for bipolar mania
- 10 to 15 mg per kilogram per day for seizures
- 500 mg once daily for migraine prevention
These doses may be adjusted depending on how the medication is tolerated and how symptoms respond in the first few weeks.
Adjusting the Dose Over Time
The initial dose is just a starting point. A provider may increase or decrease the amount depending on what shows up in follow-up visits. Some people respond well to lower doses, while others may need adjustments to reach a stable effect. Blood tests may be ordered to check Depakote levels and ensure they’re in a safe range. Ongoing adjustments are common and help balance the benefits of treatment with any side effects that might come up.
Stopping Depakote Safely
Stopping Depakote safely requires time and patience. Depakote should not be stopped all at once. If the medication is reduced too quickly, it can cause serious symptoms. These may include mood swings, physical discomfort, or in some cases, seizures. When it’s time to stop, the process needs to be slow and guided by a doctor.
Depakote Withdrawal Symptoms
As Depakote leaves the system, the nervous system becomes more active. This can bring on a range of Depakote withdrawal symptoms, especially if the dose is cut too fast. People may notice:
- Nausea
- Headaches
- Anxiety or irritability
- Trouble sleeping
- A return of manic symptoms, if Depakote was used for bipolar disorder
- Seizures, even in those without a previous diagnosis
These reactions are less likely when the dose is reduced slowly. Still, they’re important to be aware of, especially for people who’ve been taking the medication for a long time.
Tapering Off Depakote
Gradually tapering off Depakote helps lower the dose in a way the body can handle. The plan will look different depending on the dose, how long someone has been on Depakote, and the reason it was prescribed. Most tapers happen over a few weeks, with small changes spaced out across several days.
Doctors often recommend the following for stopping Depakote safely:
- Cutting back the dose a little at a time
- Watching for signs of withdrawal or symptom return
- Checking in regularly to adjust the pace, if needed
- Running labs in some cases, especially when doses were high
Going slowly gives the brain time to adjust. Even when things feel stable, a taper should never be rushed. It’s about easing off the medication while keeping symptoms in check.
Depakote vs Lamictal
Depakote and Lamictal are both used to treat bipolar disorder, but they work in different ways. Depakote contains valproic acid (or divalproex sodium), and Lamictal contains lamotrigine. When you compare Depakote vs Lamictal, you’ll discover that both are mood stabilizers, but they work differently.
Depakote is more often used to manage mania, while Lamictal is typically prescribed to prevent bipolar depression. They affect different brain chemicals, and doctors may choose one over the other based on the pattern of mood symptoms someone has, or what stage in the cycle the individual is.
Get Depakote and Mental Health Treatment Advice at Mission Connection
If you’ve been prescribed Depakote for Bipolar Disorder and have questions, or you’re not sure if it’s the right fit for your mental health needs, the team at Mission Connection is here to help. Perhaps you’re just starting out with Depakote or want to walk through alternative options due to changing circumstances, we’re here to assist.
To speak with one of our experienced and licensed mental health professionals, contact us via telephone today or get started online now.
References
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- Tomson, T., Battino, D., & Perucca, E. (2016). The remarkable story of valproic acid. The Lancet. Neurology, 15(2), 141. https://doi.org/10.1016/S1474-4422(15)00398-1
- Jochim, J., Rifkin-Zybutz, R. P., Geddes, J., & Cipriani, A. (2019). Valproate for acute mania. Cochrane Library, 2019(10). https://doi.org/10.1002/14651858.cd004052.pub2
- Ichikawa, M., Katoh, H., Kurihara, T., & Ishii, M. (2016). Clinical Response to Valproate in Patients with Migraine. Journal of clinical neurology (Seoul, Korea), 12(4), 468–475. https://doi.org/10.3988/jcn.2016.12.4.468
- MedCentral. (2024, August 15). Valproate sodium intravenous. https://www.medcentral.com/drugs/monograph/1442-382412/valproate-sodium-intravenous
- Bethesda. (2012) Valproate. In LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.ncbi.nlm.nih.gov/books/NBK548284/
- Grosu, C., Hatoum, W., Piras, M., Laaboub, N., Ranjbar, S., Gamma, F., Plessen, K. J., von Gunten, A., Preisig, M., Conus, P., & Eap, C. B. (2024). Associations of Valproate Doses With Weight Gain in Adult Psychiatric Patients: A 1-Year Prospective Cohort Study. The Journal of clinical psychiatry, 85(2), 23m15008. https://doi.org/10.4088/JCP.23m15008
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