Anyone ever take Depakote?

[Lauren]

DS#2 (11) has this weird thing going on with his arm. After seeing an orthopaedic and neurologist, he's been diagnosed as having a strep infection lingering from having strep throat last winter. I want to clarify that he doesn't have strep now, but this weird lingering thing causing his movement disorder. Basically he holds hs left hand out away from his body all the time! He's left handed, but has gone back to writing with his right.

Last week we spend 5 hours at Boston Children's Hospital as they took about 7 viles of blood, did a cat scan of his brain, etc. Fortunately, they've ruled out more serious things.

So, they want to put him on Depakote for a few months which will help the arm movement disorder. They have warned me it can cause lethargy, nauseau and weight gain. Oh great!

With this medication they'll want to check his blood levels every few weeks. We also have to see Infectious Disease in a couple of weeks.

I'm hoping the medicine helps his arm, doesn't cause side effects and they can wean him off the medicine soon. He's been a trooper though!

[gabbyh]

Lauren,

I worked as a child & adolescent psychiatric nurse for over 10 years and many of the kids were on depakote for various problems...

One of the most important things is to check bloods levels, as you stated...and although as a Mom, I know the other possible side effects are frightening...but try to keep an eye on his activity level, and nutrition, and he should do fine ;-}

Some of the weight gain comes from the lethargy, and lots of high calorie foods...then there can be the opposite...no desire to eat...it may be a challenge...please feel free to PM me if you need more info, or have any specific questions...

Good luck!

~Gail

[DocAgocs]

I've had patients take this medication with mixed results, which is to be expected with pretty much anything. I would look at the book "Over Dose" which was written by a psychiatrist a few years ago. I'm posting this to scare you or anything, but the author's stance is that most medications are given at much too high of dosage, partcularly for psychiatric meds and especially when they are being used for kids, which often times the medications have not been researched on yet.

The book is by Jay Cohen, MD and it's likely you can get it at your library. The ISBN is 1585421235.

Dr. Cohen gives some guidelines and things to do to make sure your kid is getting the right dose, not necessarily the one that the drug manufacturer is wanting him to take! For example, it's been a few years since I read this book, but he mentions that most antidepressants work just as well, with many fewer side effects, at 1/2 to 1/4 of the dosage. Definitely work with your MD on this and not on your own, but get the book and read it and understand it so you're armed with this knowledge.

I'm saying this because one of my pediatric patients has some pretty severe behavioral problems and Depakote was one of about 6 psychiatric medications his MD had him on. He was experiencing lots of problems (weight gain followed by tremendous weight loss, hair was falling out, couldn't sleep or function...) and after much struggle the parents got him to a pediatric psychiatrist who actually knew what he was doing and the first thing he did was cut all the meds in half, then a few weeks later eliminated most of them and the kid did very well with this.

Best of luck and let us know how it goes!

[Ralph]

I agree with Gail to keep a close eye on him and make sure blood levels are checked.

Sounds like he's had a very thorough evaluation by the correct professionals and I would certainly trust their recommendations.

[DocAgocs]

Sounds like he's had a very thorough evaluation by the correct professionals and I would certainly trust their recommendations.

I agree, however dosing guidelines from manufacturers may not always be correct, according to some experts. I don't know if Depakote is even mentioned in Dr. Cohen's book but it's worth a look. Like I said, don't screw around with dosages yourself, but it doesn't hurt to minimize the chances of side effects or bad reactions to a medication by being sure it is used properly, right?

[Ralph]

Originally posted by DocAgocs
dosing guidelines from manufacturers may not always be correct, according to some experts.

While that may be your opinion, drugs such as Depakote are prescribed on an individualized basis, with frequent monitoring of blood levels. Therapeutic levels are not specified by the manufacturer, but rather from experts in the respective fields that have studied the drugs and their effects.

[ellery]

Another one weighing in who's seen Depakote used quite frequently for psychiatric purposes with children/adolescents with no real side effects other than weight gain, but that may have been also influenced by questionable hospital food ;) and low physical activity. I too recommend just keeping an eye on him as far as side effects, as you would with any medication prescribed, getting his blood levels checked, and keeping your physician updated if you see anything of concern.

Sorry that you all are going through this and hope that he feels better soon. Keep us posted.

:)

Leah

[DocAgocs]

Listen, Ralph, I know you're compelled to argue pretty much every point I say (unless I agree with you), and that's fine if that's how you like to spend your day, but I don't see any harm in empowering patients or parents of patients with information. Heck, I don't even know if Depakote is mentioned in that book. That's why I recommended the book...it was written by a prescribing physician who has used this stuff and he's got an opinion on it. I don't know why that's so threatening, but perhaps you can explain it to me.

[DocAgocs]

I know I'm not a medical doctor, and therefore I haven't even earned the right to think about drugs, much less express an opinion about them, but Abbott Laboratories, the manufacturer of Depakote, has the following to say about the drug and its effectiveness on children:

From page 12 of the 2003 revision of the prescribing information:

The safety and effectiveness of DEPAKOTE for the treatment of acute mania has not been studied in individuals below the age of 18 years.

The safety and effectiveness of DEPAKOTE for the prophylaxis of migraines has not been studied in individuals below the age of 16 years.

So, whatever.

Additionally, DEPAKOTE is intended for the use of migraines, mania and epilepsy (according to Abbott Labs) and so I assume, although I rarely actually know what I'm talking about, that DEPAKOTE being used for the problem of holding your left hand out away from your body is considered "off label" usage, i.e. it has not been studied for that type of problem, but doctors have observed its usefulness in a clinical setting and therefore will use it even though the company doesn't recommend it.

By the way, this sort of clinical observation/treatment strategy is the very thing "evidence based medicine" has ranted and raved about chiropractic for since 1895 ("You can't claim that chiropractic can help with XYZ! There are no studies to support it!") yet it is routinely done every day on millions of prescription pads across the country. Not that that is necessarily wrong (you can't do a double-blinded study for everything), but it is an interesting double standard.

So, based on the information coming from Abbott Labs, who I assume does know what they're talking about, I'd still look into the proper use of Depakote for this problem, but information may be tough to get since there are no official guidelines for using this drug in this way on patients of this age. That doesn't mean it can't or won't help, though, and again, best of luck to you and your son and I hope the problem is taken care of quickly and without problems!

PS: don't use aspirin and Depakote together, in case you haven't been warned about that.

[DocAgocs]

Ellery (I assume) just emailed me to tell me I'm beating a dead horse and I realize in my enthusiasm of discussing all things related to health care I sort of highjacked this topic for my own evil purposes. Sorry, Lauren.

PS: The prescribing info for DEPAKOTE is available to download as a PDF from http://www.abbott.com. I made the mistake of typing in "Abbottlabs.com" originally and it's completely unrelated to Abbott!

Anyway, unless someone has a specific question for me relating to this post I'll shut my mouth now.

[ellery]

Originally posted by DocAgocs
Ellery (I assume) just emailed me to tell me I'm beating a dead horse and I realize in my enthusiasm of discussing all things related to health care I sort of highjacked this topic for my own evil purposes. Sorry, Lauren.

Hold up - leave me out of this. I've been busily working while you've been arguing. I haven't emailed anyone. Leave me out of this.

Leah

[DocAgocs]

Sorry. Email was from an Eileen, so it seemed to match Ellery. Sorry, shouldn't have assumed!

[ellery]

Yeesh. :mad:

Leah

If you have anything to say to me, feel free to pm me, as opposed to further hijacking this thread...

[Lauren]

Thanks all for the support and feedback. DS started the med today. I was thrilled that he could swallow the pills, as I didn't know he could and still give him chewable Tylenol. Since he has to take two small pills twice a day - this is a good thing!

I feel better about this medication. Hoepfully he doesn't experience any side effects and as I mentioned, I think he will be taking the med for 90 days. They took blood today and I know they'll check it again in two weeks. At Childrens Hospital last week they did an EKG. Apparently this strep infection can cause heart damage, but all was fine.

In addition to the advice from the doctors at Childrens, we discussed it at great length today at our holiday dinner. FIL is an allergist and our cousin is a pediatrician. ;)

[Ralph]

Originally posted by DocAgocs
I know I'm not a medical doctor, and therefore I haven't even earned the right to think about drugs, much less express an opinion about them,

You hit the nail right on the head there, buddy! Until you have a license to prescribe medicine, I'd recommend refraining from comment on prescription medication.

I've refrained from flaming you here and on any other thread, for that matter. Now you've crossed the line. I feel compelled to provide correct medical/clinical information when it's been mis-spoken here or elsewhere on the BB.

You're busy quoting Abbott's information. Well, they're not allowed to share that information unless it's approved by the FDA. And I'll correct your misunderstanding of off label use: In order to be used off-label, a drug has been studied for that particular use; the FDA just hasn't formally approved it for that use.

As to Lauren's son, you're saying that the well-educated, professional sub-specialists he's seen really don't know what they're doing, and as long as they find a dosage "guideline" in manufacturer's information, they'll just wing it. PUH-LEEZE! :rolleyes:

[gabbyh]

Lauren,

So glad things are working out for your son...I had to chuckle when I read about the chewable tylenol...I swear my son still chewed them til he was 21! He had major problems with swalllowing pills!

Continued good luck.

~Gail

[Lauren]

Originally posted by Ralph
As to Lauren's son, you're saying that the well-educated, professional sub-specialists he's seen really don't know what they're doing, and as long as they find a dosage "guideline" in manufacturer's information, they'll just wing it. PUH-LEEZE! :rolleyes:

The Neurologist at Children's Hospital is Harvard educated ... MD and PHD.

I had to laugh, DS thought he had more movement in his shoulder/arm this morning, after one day on the med! :D

[DocAgocs]

Message edited/deleted. What a tiresome double standard, Ralph.

Glad your son is feeling better. Placebo effect is a wonderful thing, as it takes several days to build to appreciable clinical levels in the system, although who knows for an 11 year old, and since the mechanism by which DEPAKOTE works hasn't been figured out, who cares, right?

[ellery]

Doc, can you argue with Ralph via pm's?

It seems kind of inappropriate to hijack Lauren's thread like this. Just a thought.

[AnnaSue]

Originally posted by DocAgocs
although I rarely actually know what I'm talking about

Well, at least you admit it.

[lakelady1]

Interesting that Ralph and AnnaSue live in towns right next to each other -- you guys related?? ;)

[Terri_A]

Lauren,

I am an epileptic ( a nice little side effect of having Lupus ) and for a time I took Depakote. My neurologist was very good about informing me about the possible side effects and what to watch for. I also was monitored very closely with blood level checks. I had no real problems with Depakote and think that is the case with most people who are properly monitored by a licensed medical practioner.

As a side note, I also happen to be well versed in prescription drugs simply as I work for one of the leading pharmaceutical companies worldwide. I will say that almost every drug made is used on a daily basis by physicians for an "off-label" indication. In fact, did you know that Rogaine was actually a blood pressure medication that happened to have the side effect of growing hair? In cases like that it is financially wise to incur the huge research costs to get FDA approval for another indication, however, the vast majority of the time, it's not and companies don't. No physician, but especially no pediatrician, would prescribe something they felt was not beneficial and the right thing for the patient.

Okay...I'm off my soapbox.

Lauren, I'm glad your son is doing well and please keep us posted on his progress!