PsychRounds: The Psychiatry Podcast Mood Stabilizers: Valproic Acid (Depakote)
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Jul 10, 2024 Dive into the fascinating history and uses of Valproic Acid, originally for seizures but now vital for bipolar disorder. Uncover its mechanism of action and the controversial links between bipolar disorder and epilepsy. Learn about the critical risks, especially for women, and the potential impact on reproductive health. Explore different formulations, dosages, and the significance of timing for effective outcomes. Plus, discover how this medication addresses impulsivity while comparing its side effects to antipsychotics. A nuanced look at benefits and risks awaits!
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Valproate's Origin and Kindling Effect
- Valproic acid is an anti-epileptic that was repurposed as a mood stabilizer for bipolar disorder due to the "kindling effect" theory.
- This theory suggests repeated stressors can trigger mania similar to repeated brain stimulation causing seizures.
Valproate Effective Acutely, Questionable Chronically
- Valproate has good evidence for treating acute mania, with faster onset than lithium but slower than antipsychotics.
- Its role in bipolar maintenance is controversial with mixed research and a trend favoring other agents for long-term use.
Avoid Valproate in Women of Reproductive Age
- Avoid prescribing valproate to women of reproductive age due to high teratogenic risks including neural tube defects and neurodevelopmental disorders.
- Recommend strong contraception counseling as unintended pregnancies are common and mania increases pregnancy risk.