Ask the Therapist
Depakote and Depression
One year ago, my then 17 year old daughter was under a
psychologists care for depression. As part of her therapy, she was put on a mild dose of Celexa, which apparently caused her to mildly hallucinate. This appeared to set off a series of hypo-manic episodes, resulting in a diagnosis of rapid cycle bi-polar 2. She was put on Depakote to treat the mania, and Effexor to treat the depression. She continued under the care of the psychologist.
Her depression has been steadily increasing to the point where she often cannot get out of bed. Often she has trouble sleeping. The psychiatrist added Wellbutrin to the mix, but she did not respond well, getting
palpitations and shakes. As a rule, she seems to have issues with anti-depressants. She was overweight to begin with, and the Depakote and depression have only made things worse on that front. Other than weight, things seem to be going well. She has made many friends in the past year at college. She did well in classes last semester, and other than missing classes because she can't get up, seems to be doing well this semester.
At the time of the initial diagnosis of bipolar, there was an alternative diagnosis of a personality disorder by the
psychiatrist. The psychologist was unsure of the bipolar diagnosis also, feeling that it may have been just the anxiety of applying to college and going away to school that may have been the root.
So, my question is, if she is not, in fact, bipolar, could the Depakote be causing or accentuating the depression? Even if she is bipolar,
could the Depakote be causing the issues of not being able to get up? Are there alternatives we should be looking into? The
psychiatrist is very defensive about this and gets annoyed when we ask him questions (note, she will be seeing a new
psychiatrist very soon). Note, we will not do anything without consulting a psychiatrist, I just want to be able to ask the right questions and not waste time with something that could not be the cause.
Every case is different, so I can't comment directly. However, the information you've provided would clearly suggest that there is some relationship between the medications and the exacerbation of symptomology. That said, my professional strategy -- and this is an opinion, not a prescription -- would be to get her off of everything and start over.
Another note...personality disorders, whether specific or mixed, are clearly evident. Professionals often get trapped by their own need to assign a category to a set of behaviors when in fact they are looking at simple disorganization, a shadow syndrome, a symptomatic disorder, etc. If a psychologist cannot make a definitive statement about the presence of personality or characterological disorder based on anecdotal or assessment evidence, it shouldn't be part of the conversation.
