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Dr. Bob is Robert Hsiung, MD,
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Posted by Lou Pilder on September 30, 2014, at 8:20:34
In reply to Re: Lou's reply-howyagonnagetum » Lou Pilder, posted by Sheilac on September 30, 2014, at 8:01:40
> I have both depakote and Trileptal at home. For the past 8 months I've only been taking Geodon it worked for depression and mood stabilization.
>
> The elavil has thrown me into a hypomanic state.
>
> I'm not sure what med to take, but I have to do something before I go crazy. I don't think Geodon is a good mood stabilizer with elavil.S,
You wrote,[...I'm not sure what med to take...I have to do something...].
I am unsure as to what you are wanting to mean here If you could post answers to the following, then I could have the opportunity to respond accordingly.
True or False:
A. The only choice that I have, Lou, is to take either Trileptal or Depakote
B. My prescribing doctor says that I can take drugs without consulting him/her that I have shelved from previous prescriptions.
C. I know, Lou, what the tragic consequences could be to me by combining the drugs that I am already taking with either Depakote or Trileptal.
D. I will either add Depakote or Trileptal to the drugs that I am taking now, on the basis of what another poster says to me here.
Lou
Posted by SLS on September 30, 2014, at 10:00:12
In reply to Re: Depakote + Elavil ?! » Christ_empowered, posted by Sheilac on September 30, 2014, at 6:19:40
You might want to discontinue the Elavil for now and develop a coherent plan to follow with your doctor. That would be the simplest thing to do.
You are not necessarily experiencing serotonin syndrome, so I would not act on that conclusion until you gather more information. It could explain things, though.
If you feel that it is urgent to treat mania, go with what you know works for you, understanding that it will only be a temporary measure. In other words, if Trileptal or Depakote works to treat the mania, but produces depression as a side effect, just know that you will be able to discontinue it once you and your doctor meet and discuss your present condition.
You often contradict yourself in your descriptions. Because of this, I am reluctant to say very much more than to recommend that you work more closely with your present doctor or search for a different doctor. You could go for a second opinion. I know it is frustrating to be in a painful state and not be able to do something about it immediately.
- Scott
Posted by Sheilac on September 30, 2014, at 10:33:27
In reply to Lou's reply-tehykehychanz » Sheilac, posted by Lou Pilder on September 30, 2014, at 8:20:34
So noted. I get your point. Luckily my doc called me and said I should not be taking Geodon and Elavil. She switched me over to depakote so the Elavil won't make me manic.
Posted by Sheilac on September 30, 2014, at 10:38:34
In reply to Re: Depakote + Elavil ?! » Sheilac, posted by SLS on September 30, 2014, at 10:00:12
Thanks Scott. Yes it is terrible to feel so hypomanic. But unfortunately the Elavil is working for my pain condition. My doc did call me and said to wean off Geodon immediately and add the depakote, which I will do until I see her next time.
I don't think the depakote will induce depression considering the Elavil is having a profound antidepressant effect on me.
My doctor agreed.
Posted by SLS on September 30, 2014, at 12:06:40
In reply to Re: Depakote + Elavil ?! » SLS, posted by Sheilac on September 30, 2014, at 10:38:34
> Thanks Scott. Yes it is terrible to feel so hypomanic. But unfortunately the Elavil is working for my pain condition. My doc did call me and said to wean off Geodon immediately and add the depakote, which I will do until I see her next time.
>
> I don't think the depakote will induce depression considering the Elavil is having a profound antidepressant effect on me.
>
> My doctor agreed.
Sounds good to me!:-)
- Scott
Posted by Lou Pilder on September 30, 2014, at 21:02:51
In reply to Re: Lou's reply-tehykehychanz » Lou Pilder, posted by Sheilac on September 30, 2014, at 10:33:27
> So noted. I get your point. Luckily my doc called me and said I should not be taking Geodon and Elavil. She switched me over to depakote so the Elavil won't make me manic.
>
> S,
Now you have a whole new host of life-threatening problems by adding the Depakote to replace the Geodon. You see, Depakote can cause a disruption of the heart beat function with the other drugs that you take and be life-threatening. Also, confusion and seizures, and movement disorders and poor judgment can also come from this combination. And Depakote can attack the organs and cause even blood disease. Suicidal and homicidal thinking can emerge with this combination.
Lou
Posted by SLS on September 30, 2014, at 21:32:43
In reply to Lou's reply-leadztudizstrkun » Sheilac, posted by Lou Pilder on September 30, 2014, at 21:02:51
Are these effects dosage-dependent?
- Scott
Posted by Lou Pilder on October 1, 2014, at 8:05:06
In reply to Re: Lou's reply-leadztudizstrkun » Lou Pilder, posted by SLS on September 30, 2014, at 21:32:43
> Are these effects dosage-dependent?
>
>
> - ScottScott and friends,
The use of the drug called Depakote has a wide range of adverse effects just taken by itself. But these effects are much greater when the drug is combined with the drugs that our member here is taking. The adverse effects are magnified exponentially when combined with other psychoactive drugs This means that when taken in combination with other psychotropic drugs, the chance of , let's say, death from liver failure or failure of the pancreas or death from blood disease is {exponentially} increased. So the dosage as taken as directed will be exponentially magnified in the creation of death by organ disease such as the liver or pancreas. As to if there is some low dose that could not induce these tragic consequences, I do not think so, for there is the exponential effect when taken in combination with other drugs that act on the nervous system.
The drug has constituents that have been known for thousands of years to effect the mind. The drug was used by sorcerers in the ancient times. And today, there are a new generation of sorcerers giving the drug with the same consequences that can lead to death.
And here, this drug is allowed to be openly promoted to be taken in combination with other psychoactive drugs that could kill the person taking those drugs. And if the drug itself does not kill the person by liver failure or blood disease or disease of the pancreas, such confusion from the drug could cause the taker of the drug to act irrationally and be killed accidentally. Oh, the horrors of it all
Here is a link noting the effects from the drug.
http://www.rxlist.com/depakote-side-effects-drug-center.htm
Lou
Posted by Sheilac on October 1, 2014, at 8:13:58
In reply to Re: Lou's reply-leadztudizstrkun » Lou Pilder, posted by SLS on September 30, 2014, at 21:32:43
My doc did not feel it was safe for me to be on Geodon and a trycylic.
She checked the combo of low dose Elavil and low dose depakote and said it was fine.
Do you just not like meds at all Lou?
Posted by Lou Pilder on October 1, 2014, at 8:30:44
In reply to Re: Lou's reply- lou + Scott, posted by Sheilac on October 1, 2014, at 8:13:58
> My doc did not feel it was safe for me to be on Geodon and a trycylic.
>
> She checked the combo of low dose Elavil and low dose depakote and said it was fine.
>
> Do you just not like meds at all Lou?S,
You wrote the above. And you say that your doc agreed with me that the combination of Geodon and Elavil was not safe. Then if I am following this correctly, some doctor prescribed the combination to you thinking that it was safe? Was it the same doctor?
Now she says that it is fine to take Depakote with Elavil in a low dose. Where does she get such assurance?
Lou
Posted by SLS on October 1, 2014, at 9:16:02
In reply to Re: Lou's reply- lou + Scott, posted by Sheilac on October 1, 2014, at 8:13:58
> My doc did not feel it was safe for me to be on Geodon and a trycylic.
>
> She checked the combo of low dose Elavil and low dose depakote and said it was fine.
>
> Do you just not like meds at all Lou?I think that Lou Pilder usually has noble motivations.
Mr. Pilder's observation that there is the potential for a combination of Geodon (ziprasidone) and Elavil (amitriptyline) to produce changes in heart rhythm is justified. However, I don't know under what circumstances this is liable to occur. I, myself, had no problems when I combined desipramine 200 mg/day with Geodon 80 mg/day.
Regarding Depakote (valproate) and liver toxicity, this adverse effect is dosage dependent, and easy to screen for. One should have a blood test for liver enzymes before taking Depakote in order to establish baseline measurements. This should be repeated periodically during the first six months, whereafter, the probability of liver toxicity declines rapidly. Full liver failure is considered to be a rare occurrence.
At higher dosages, one should assay blood platelet function to screen for thrombocytopenia (low platelet count).
- Scott
Posted by Sheilac on October 1, 2014, at 11:58:29
In reply to Lou's reply- whtzonpsecun » Sheilac, posted by Lou Pilder on October 1, 2014, at 8:30:44
No. One doc gave me Elavil to take for neuropathy and she said she didn't know what Geodon was! Now adays with all the electronic health records, you'd think it would have raised a red flag.
It was only after a week of getting more and more manicy that I called my pdoc and she was not comfortable with the possible heart issues when combining Elavil with Geodon. She was very frustrated with my other doctor.
My pdoc told me to wean down/off Geodon and take Depakote to calm down the hyperness the antidepressant (Elavil) was causing.
She also mentioned that depakote could increase the blood levels & side effects of Elavil. She mentioned that some people take depakote for neuropathy. It's not usually the first choice, but she said it might also help with that.
So I'm taking only 20mg of Elavil now in the morning because it revs me up (was taking 30). And I'm taking 250mg depakote at night, but this morning I felt jittery still, so I took 125mg of Depakote. I'm not taking in any caffeine or stimulant of any type.
My pdoc is fine with this. She wants me to stay stable until I see her in 2 weeks.
I'm a low dose girl, so 250mg of depakote really does help.
Posted by Lou Pilder on October 1, 2014, at 12:56:49
In reply to Re: Lou's reply- whtzonpsecun » Lou Pilder, posted by Sheilac on October 1, 2014, at 11:58:29
> No. One doc gave me Elavil to take for neuropathy and she said she didn't know what Geodon was! Now adays with all the electronic health records, you'd think it would have raised a red flag.
>
> It was only after a week of getting more and more manicy that I called my pdoc and she was not comfortable with the possible heart issues when combining Elavil with Geodon. She was very frustrated with my other doctor.
>
> My pdoc told me to wean down/off Geodon and take Depakote to calm down the hyperness the antidepressant (Elavil) was causing.
>
> She also mentioned that depakote could increase the blood levels & side effects of Elavil. She mentioned that some people take depakote for neuropathy. It's not usually the first choice, but she said it might also help with that.
>
> So I'm taking only 20mg of Elavil now in the morning because it revs me up (was taking 30). And I'm taking 250mg depakote at night, but this morning I felt jittery still, so I took 125mg of Depakote. I'm not taking in any caffeine or stimulant of any type.
>
> My pdoc is fine with this. She wants me to stay stable until I see her in 2 weeks.
>
> I'm a low dose girl, so 250mg of depakote really does help.S,
You wrote the above
Now I don't claim to be an "A" student. But this much I know. The literature states that Depakote can induce fatal agranulocytosis as well as other blood abnormalities that could cause death. This is compounded by the fact that you are taking other psychotropic drugs along with Depakote.
Now Scott says that before one takes Depakote, an assessment for determining if liver failure could happen is made. Did your doctor order this assessment for you before you took the Depakote?
Now you have a doctor allowing you to take Elavil along with Depakote. I guess you trust him/her. But I say to you, if the one doctor was negligent by not checking other drugs that you were taking, and if there is now another doctor involved, could not this doctor also be negligent that could cost you your life? Does that a doctor prescribes one a drug(s) make it so that one could not die from the drug(s)?
Lou
Posted by Lou Pilder on October 1, 2014, at 13:13:21
In reply to Lou's reply-ehydonoizonthrd » Sheilac, posted by Lou Pilder on October 1, 2014, at 12:56:49
> > No. One doc gave me Elavil to take for neuropathy and she said she didn't know what Geodon was! Now adays with all the electronic health records, you'd think it would have raised a red flag.
> >
> > It was only after a week of getting more and more manicy that I called my pdoc and she was not comfortable with the possible heart issues when combining Elavil with Geodon. She was very frustrated with my other doctor.
> >
> > My pdoc told me to wean down/off Geodon and take Depakote to calm down the hyperness the antidepressant (Elavil) was causing.
> >
> > She also mentioned that depakote could increase the blood levels & side effects of Elavil. She mentioned that some people take depakote for neuropathy. It's not usually the first choice, but she said it might also help with that.
> >
> > So I'm taking only 20mg of Elavil now in the morning because it revs me up (was taking 30). And I'm taking 250mg depakote at night, but this morning I felt jittery still, so I took 125mg of Depakote. I'm not taking in any caffeine or stimulant of any type.
> >
> > My pdoc is fine with this. She wants me to stay stable until I see her in 2 weeks.
> >
> > I'm a low dose girl, so 250mg of depakote really does help.
>
> S,
> You wrote the above
> Now I don't claim to be an "A" student. But this much I know. The literature states that Depakote can induce fatal agranulocytosis as well as other blood abnormalities that could cause death. This is compounded by the fact that you are taking other psychotropic drugs along with Depakote.
> Now Scott says that before one takes Depakote, an assessment for determining if liver failure could happen is made. Did your doctor order this assessment for you before you took the Depakote?
> Now you have a doctor allowing you to take Elavil along with Depakote. I guess you trust him/her. But I say to you, if the one doctor was negligent by not checking other drugs that you were taking, and if there is now another doctor involved, could not this doctor also be negligent that could cost you your life? Does that a doctor prescribes one a drug(s) make it so that one could not die from the drug(s)?
> Lou
>
S,
The issue here could mark the difference between you being a live person or a corpse. Here is a link concerning Depakote and warnings.
Lou
http://www.drugs.com/pro/depakote-capsules.html
Posted by herpills on October 1, 2014, at 13:28:36
In reply to Re: Lou's reply-leadztudizstrkun » Lou Pilder, posted by SLS on September 30, 2014, at 21:32:43
> Are these effects dosage-dependent?
>
>
> - ScottApparently if you take 0.00001mg you will die.
Posted by Sheilac on October 1, 2014, at 13:46:05
In reply to Re: Lou's reply-leadztudizstrkun » SLS, posted by herpills on October 1, 2014, at 13:28:36
Well geez. Maybe I should just take the Trileptal as my mood stabilizer. Would that be safer?
Maybe just Trileptal and Elavil
Posted by SLS on October 1, 2014, at 16:44:20
In reply to Re: Lou's reply-Lou » herpills, posted by Sheilac on October 1, 2014, at 13:46:05
> Well geez. Maybe I should just take the Trileptal as my mood stabilizer. Would that be safer?
>
> Maybe just Trileptal and ElavilSheila, you need to settle down and perhaps not look at Psycho-Babble for a little while.
Depakote is a relatively safe drug. The incidence of liver abnormalities is dosage-dependent. The few times when I experienced drug-induced mania, Depokote 1000 mg/day worked very well. My liver enzymes were normal at 3000 mg/day, but there was a trend towards having a lower platelet count at that dosage. Remember - I am just one person (n=1). Agranulocytosis (lower white blood cells) is listed as a "class" side effect with all of the anticonvulsants, even if a specific drug has not yet exhibited it.
Both liver failure and agranulocytosis are considered to be rare side effects of Depakote, and occur with a frequency of less than 0.1%.
Unlike the occurrence of liver function abnormalities, agranulocytosis is not dosage-dependent with Depakote. If your are worried about this happening, just ask your doctor to include WBC along with liver enzymes when you get your blood test - something that should be done as soon as your doctor gets back.
- Scott
Posted by Sheilac on October 1, 2014, at 17:40:32
In reply to How is PB helping you? How is PB hurting you? » Sheilac, posted by SLS on October 1, 2014, at 16:44:20
Thanks Scott. I was freaking out after reading all the terrible things that could happen from taking 250-375mg of Depakote.
I would imagine that 250mg is such a low dose (even though it works for me) and it takes away the Elavil antidepressant hypomania. I just couldn't understand how such a low dose could kill me.
It's working and I haven't felt this calm in 2 weeks. My pdoc will run bloodwork on me when she gets back.
I think I'm right not to worry about the low dose, right?
I so appreciate your input. It's not like I'm taking 1,000mg.
Posted by Lou Pilder on October 1, 2014, at 20:15:06
In reply to Re: How is PB helping you? How is PB hurting you? » SLS, posted by Sheilac on October 1, 2014, at 17:40:32
> Thanks Scott. I was freaking out after reading all the terrible things that could happen from taking 250-375mg of Depakote.
>
> I would imagine that 250mg is such a low dose (even though it works for me) and it takes away the Elavil antidepressant hypomania. I just couldn't understand how such a low dose could kill me.
>
> It's working and I haven't felt this calm in 2 weeks. My pdoc will run bloodwork on me when she gets back.
>
> I think I'm right not to worry about the low dose, right?
>
> I so appreciate your input. It's not like I'm taking 1,000mg.S and friends,
If you are following this discussion and trying to make an informed decision as to take these drugs or not in question on the basis of what you read here, be advised that when psychoactive drug are combined, their effects could be magnified exponentially. And the subject here concerns the safety of Depakote as combined with Elavil and other psychotropic drugs
Now the subject of {relative safety} of Depakote has been posted But us that an ambiguous term? Let us look at some statistics concerning agranulocytosis and Depakote Notice that over 3% of those with reported adverse effects have agranulocytosis. That is a large statistical number. And it happens at first in the 6 mo of taking the drug more than other times. Now as something being dose related, you could think that the adverse event would happen later as an accumulation, but it strikes at the first 6 mo more.
And then there is panceatitis that I will go into later I want readers to make their own determination as to if Depakote is a drug for you and see the facts .
Here are two links showing some of these facts.
Lou
http://www.ehealthme.com/ds/depakote+er/agranulocytosis
http://www.drugcite.com/indi/?q=Depakote&i=AGRAULOCYTOSIS
Posted by Phillipa on October 1, 2014, at 21:02:38
In reply to Lou's response-relatvlysayph? » Sheilac, posted by Lou Pilder on October 1, 2014, at 20:15:06
We as posters should not give med advise to others. Just our own experiences using them. Phillipa
Posted by Lou Pilder on October 2, 2014, at 5:17:14
In reply to Re: Lou's response-relatvlysayph? » Lou Pilder, posted by Phillipa on October 1, 2014, at 21:02:38
> We as posters should not give med advise to others. Just our own experiences using them. Phillipa
Friends,
Phillipa has posted her concern here that members posting advice about drugs could constitute {giving medical advice} to others. And she has a valid point in that respect. The question could become as to what is advice or not.
Now posting facts could be helpful and posting facts is not the same as giving medical advice. Facts are facts, and can be used to make a more informed decision as to take these drugs or not.
The issue at hand here is the drug called Depakote which is valproic acid. The drug can induce death via many ways by attacking the liver, pancreas, blood and other systems. These each could be low, but accumulating all the different ways that the drug could kill you, could add up to a different understanding of how death could come from taking this drug. As to how one could in some way head off death by taking tests of their blood and liver function, don't forget that death could be sudden and outside the hospital setting where tests could be done.
Here we can see statistics where sudden death attributed to Depakote has been recorded. What I am posting here is not advice, but facts. Facts that could mark the difference between you being a live person or a corpse.
Lou
http://www.ehealthme.com/ds/depakote/sudden+death
Posted by Sheilac on October 2, 2014, at 6:28:46
In reply to Lou's response-psuddeundeth » Phillipa, posted by Lou Pilder on October 2, 2014, at 5:17:14
And again, Lou, I'm assuming from your posts that you think Trileptal is a far safer med than Depakote (even if taken in low doses).
I have read your warnings about Depakote and will discuss with my doctor.
Again, I'm getting that your opinion that Trileptal would be much safer with Elavil?
Posted by Lou Pilder on October 2, 2014, at 7:31:42
In reply to Re: Lou's response-psuddeundeth » Lou Pilder, posted by Sheilac on October 2, 2014, at 6:28:46
> And again, Lou, I'm assuming from your posts that you think Trileptal is a far safer med than Depakote (even if taken in low doses).
>
> I have read your warnings about Depakote and will discuss with my doctor.
>
> Again, I'm getting that your opinion that Trileptal would be much safer with Elavil?S,
Let us reason together. Let us look at this criminal case against the manufacturer of Trileptal.
Lou
http://www.justice.gov/usao/pae/News/Pr/2010/Sept/norvartis_entryofplea.pdf
Posted by Lou Pilder on October 2, 2014, at 7:40:59
In reply to Lou's response-wulvz » Sheilac, posted by Lou Pilder on October 2, 2014, at 7:31:42
> > And again, Lou, I'm assuming from your posts that you think Trileptal is a far safer med than Depakote (even if taken in low doses).
> >
> > I have read your warnings about Depakote and will discuss with my doctor.
> >
> > Again, I'm getting that your opinion that Trileptal would be much safer with Elavil?
>
> S,
> Let us reason together. Let us look at this criminal case against the manufacturer of Trileptal.
> Lou
> http://www.justice.gov/usao/pae/News/Pr/2010/Sept/norvartis_entryofplea.pdfcorrection of link:
http://www.justice.gov/usao/pae/News/Pr/2010/Sept/novartis_entryofplea.pdf
Posted by SLS on October 2, 2014, at 7:59:19
In reply to Re: Lou's response-psuddeundeth » Lou Pilder, posted by Sheilac on October 2, 2014, at 6:28:46
> And again, Lou, I'm assuming from your posts that you think Trileptal is a far safer med than Depakote (even if taken in low doses).
>
> I have read your warnings about Depakote and will discuss with my doctor.
>
> Again, I'm getting that your opinion that Trileptal would be much safer with Elavil?Like me, Lou Pilder is but one person offering opinions.
I encourage you to do your own research before making any changes. One important source of information is your doctor.
In the past, you described that Trileptal made you feel more depressed.
By the way, Trileptal is said to have the potential of producing agranulocytosis. This is written in the black-box warning from the manufacturer. Again, like valproate, this is a rare occurrence.
Another unsolicited piece of advice that I have for you is that you try to reign in your anxiety and impulsivity. You are not going to die between now and when your doctor gets back.
- Scott
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Dr. Bob is Robert Hsiung, MD,
[email protected]
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