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    Dr. Goldberg
    BeeRJ posted:
    I'm new to the exchange and the hole medical world withen bp. I wanted to now if when in my manic stages, or when elevated, if taking a higher dose of my meds during that time is o.k. I take only depakote 2 500mg right now wanted maybe go two and a half. I am a rapid cycler. I also am trying to track moods and such and right now it is like a 4 day cyle still trying to figure out if that is being init or leading up to it or going from low or high. Also do not have any real side effects thus.
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    Joseph F Goldberg, MD responded:
    Dear BeeRJ,

    Rather than think of a medicine like Depakote as a medicine to adjust day-to-day or week-to-week, ask your doctor what your blood level is. If you are having signs of mood elevation, increased energy, not sleeping, talking/thinking fast, etc., and a 10-14 hour valproic acid level is subtherapeutic (ie, <50 mcg/dl...and, preferably, at least 70-80 mcg/dl), then it should be raised sufficiently to reach a therapeutic level. The rule of thumb is that a dose that produces a therapeutic level is roughly your weight in pounds with a zero after it (so, if you weigh 150 pounds...1500 mg/day). If the medicine is already in the therapeutic range and symptoms persist, then it's probably wiser to add a 2nd medicine to the 1st. In true rapid cycling (i.e., 4 or more episodes per year, with an episode lasting at least several days for mania and 2 weeks for depression....separated by recoveries), the odds of Depakote alone working are only about 10-15%. With a 2nd mood stabilizer like lithium, about double that.

    - Dr. G.

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