Depakote (Valproic acid) is a compound that is utilized as an anticonvulsant to help prevent seizures in epileptics. It also has mood stabilizing properties and is approved to help treat and prevent mania among individuals with bipolar disorder. In some cases it is prescribed for the treatment of migraine headaches as well. Other off-label uses for Depakote include: impulse control disorders and spasms.
Most people that use it for the intended purposes of treating epilepsy and/or mania in bipolar disorder find that it works quite well. Despite the fact that the drug can be very effective, the way it works is not well understood. Some hypothesize that it may work on voltage-dependent sodium channels and may increase GABA to prevent both seizures and mania. Studies in animals have lead researchers to believe that this may inhibit the reuptake of the neurotransmitter GABA in the brain.
Although many people take this medication for a period of time, some have a difficult time dealing with side effects. Various side effects include: hair loss, nausea, diarrhea, vomiting, indigestion, and vision problems. Additionally it may lead a person to gain weight and cause memory problems. The potentially debilitating side effects are reasons people typically end up withdrawing from this medication.
Factors that influence Depakote (Valproic acid) withdrawal
When coming off of any medication, there are various factors that play a role in determining how long the withdrawal process takes as well as the severity of discontinuation symptoms. These factors include things like: the time span over which you took the drug, the dose that you were on, whether you quit cold turkey or tapered, as well as other personal factors.
1. Time Span
How long were you taking Depakote? Those who were on it for a long term may have a more difficult time withdrawing than someone who was on it for a shorter term. In general, the longer you were on a medication, the more your body becomes dependent on it for functioning. Someone who is on Depakote for a few months is likely going to have an easier time coming off of the drug than someone who was on it for years.
Individuals that were on a higher dosage tend to have a more lengthy withdrawal than individuals on a lower dose. When you are on a high dose, your brain and body become used to the higher levels of the drug for functioning. Therefore it takes longer to taper as well as readjust after you quit from a high level of the medication.
The initial starting dose of this drug is 25 mg/kg per day in an extended release (ER) formula. The dose is then titrated upwards to the lowest possible dose that yields therapeutic effects. The maximum recommended dose is 60 mg/kg per day. If you are at the upper end of the spectrum (e.g. 60 mg/kg per day), you may have a tougher time withdrawing.
3. Cold Turkey vs. Tapering
It is always recommended to conduct a gradual taper off of anticonvulsant medications. Since this is a drug that affects various neurotransmitters as well, it is important to gradually taper as opposed to quitting “cold turkey.” By slowly tapering, you are giving your body and brain some time to gradually adapt as you get used to functioning with less of the drug.
If you quit cold turkey, you may experience more debilitating withdrawal effects for a longer period of time. Quitting cold turkey essentially strips your nervous system of a stimuli that it was used to receiving for a long period of time. In some cases, by not tapering, it is thought that you may shock the nervous system and it may take even longer to readjust to functioning without the drug.
Most sources suggest tapering at a rate of 20% to 25% every 2 weeks. You could taper slower or quicker, but this makes roughly for about a 2 month withdrawal period. Even 25% may be too quickly for you if you have been on the drug for a long period of time at a high dose. Take the time to work with a professional and come up with a custom plan to minimize withdrawal symptoms. To be on the safer side you could even reduce at a rate of 15% every 2 weeks.
4. Individual Factors
Other individual factors will play a role in determining the difficulty of your withdrawal. These factors include things like: social support, daily habits, and your individual sensitivity to drug withdrawal. People that get wrapped up in physical symptoms and/or those who constantly analyze every symptom that they experience during withdrawal may have a much more difficult time handling the process.
It is also important to note that some people may be on other drugs and/or transitioning to a new medication which may ease many of the withdrawal symptoms. It is important to avoid comparing yourself to what other people are experiencing and/or how long their withdrawal lasts. You may experience a much quicker withdrawal or yours may be much longer and more drawn out – it totally depends on your circumstances.
Depakote Withdrawal Symptoms: List of Possibilities
Below are a list of possible symptoms that you may experience when coming off of Depakote. Keep in mind that you may not experience every symptom listed below and that the severity of what you experience will largely be based on individual circumstances.
- Anger: Some individuals report feeling anger to the point of rage when they initially come off of this drug. It may have to do with the fact that the drug itself tends to elicit a calming response – inhibiting the reuptake of GABA. When stopped, this may lead a person to feel more angry than usual.
- Anxiety: If you notice that you feel more anxious and less relaxed, it’s largely due to withdrawal. It is pretty common to experience anxiety and have anxious thoughts when you initially stop this medication. If you didn’t have anxiety prior to taking this drug, you should gradually become less anxious over time.
- Bipolar relapse: For those who have bipolar disorder and are on the drug to help control manic cycling, you may experience mania when you quit. When you take away the drug that was helping control the cycling, it is possible to experience a shift in mood.
- Concentration problems: A very common problem that people report during the first couple weeks of withdrawal is concentration problems. These can be more severe if you quit cold turkey or taper too quickly. In general you may have a difficult time staying focused and completing work or school-related tasks.
- Confusion: There are a combination of symptoms that contribute to feeling confused. These include things like: foggy thinking, poor concentration, mood swings, memory issues, and physical symptoms. The confusion should ease up as your brain gradually begins to function without the drug.
- Depression: Another common symptom to experience is that of depression. Although Depakote does not prevent cycling into depression, coming off of it can lead a person to feel depressed. It could be in part due to neurotransmitter changes, particularly involving GABA.
- Dizziness: Perhaps the most common symptom associated with the withdrawal process is that of dizziness. Many people report feeling extremely dizzy and or have sensations of vertigo. If you feel dizzy, just know that it will improve in time. If you quit cold turkey, this may be significantly more severe.
- Fatigue: Do not be surprised if you feel pretty tired with low energy for the first couple weeks after you quit this drug. Do your best to work with the energy that you’ve got and eventually you should notice your energy levels increase.
- Headache: Many people experience general headaches when they stop this medication. Individuals that were taking Depakote for migraines may notice rebound migraines upon discontinuation.
- Insomnia: This drug tends to calm people down and can make individuals sleepy. When you discontinue, you may notice that you experience an inability to fall asleep at night. This may be in part due to anxiety and/or inadequate GABA.
- Irritability: It’s pretty normal to feel irritable when withdrawing from this drug. Expect the irritability to slowly decline in intensity over the course of a few weeks following your last dose.
- Mood swings: It is common to experience general mood swings (non-bipolar) upon discontinuation of this medication. One moment you may feel very angry, the next depressed, and the next very anxious. Just know that you may experience some general fluctuation in moods as you recover from withdrawal – these will eventually subside.
- Muscle weakness: Some people tend to experience muscle weakness and/or pains when they initially quit this drug. This weakness should improve gradually over the course of a few weeks until you no longer feel weak.
- Nausea: In some cases, people end up feeling nauseated if they taper too quickly or during the first week of withdrawal. This nausea may be unpleasant, but keep in mind that it will eventually subside.
- Seizures: If you have epilepsy you may experience rebound seizures during withdrawal if you remain unmedicated. It is always important to make sure that you slowly taper from AED’s or you could experience a seizure. If you are unsure of a good tapering protocol, talk to a professional.
- Sleep changes: You may experience changes in your sleep patterns during withdrawal. In other words, you may have difficulty falling or staying asleep or you may sleep too much. You may also have difficulty sleeping at normal times (e.g. sleepy during the day and unable to sleep at night).
- Suicidal thinking: In some cases, the depression that people deal with during withdrawal can lead to suicidal thinking. If you are feeling suicidal and haven’t felt this way before taking the medication, you should recover to normal thinking in some time. In the meantime, be sure to see a therapist and talk about your feelings if they are extreme.
- Tremors: Withdrawal can lead some individuals to experience shakes or tremors upon discontinuation. These can be minimized if a proper tapering protocol is followed, but if a person quits too quickly, the tremors may be severe.
- Vision changes: It is common to experience vision changes while taking the drug. Some people experience similar vision changes when they withdraw as well. Over time your vision should return to normal functioning – give it some time.
- Weight loss: Since many people gain weight when they take Depakote, it should be obvious that they are going to lose it when they stop taking it. If you gained weight while on the drug, you should eventually lose most of it as time continues to pass. The weight loss will not be immediate, but should occur gradually.
How long do Depakote withdrawal symptoms last?
There is no exact timeline for withdrawal from Depakote that applies to everyone. Your experience when coming off of any drug is going to be unique and largely based on individual circumstances. There have been cases of people withdrawing from this medication and feeling better within a week or two, and there have been other cases of people still experiencing withdrawal effects months after their last pill. In most cases, withdrawal symptoms should start to gradually lessen over a period of weeks to months.
The half life of the drug ranges from 9 to 16 hours, therefore the drug itself will be completely cleared from your system within 2 days. Although the drug will be cleared from your body in a relatively short-order, it doesn’t mean that you won’t experience any withdrawal following the second day. Depending on how long you took this medication, it may take a relatively lengthy time period for your nervous system to readjust for functioning without the drug.
Additionally this is a drug that is thought to affect neurotransmitters in the brain – particularly GABA. It may take some time before your GABA levels to reach normal levels after your withdrawal. During withdrawal do your best to realize that these discontinuation effects are not permanent – you will eventually recover to how you were before you used Depakote.
In the meantime, be sure to engage in healthy activities such as: exercise, eating right, and staying socially involved. Over time, you should notice that withdrawal symptoms gradually subside and you feel more like your old self. If you have gone through Depakote withdrawal and would be kind enough to share your experience in the comments section below, you may really help another person who is facing withdrawal.