Monday, April 20, 2009

Depakote, Pregnancy, Epilepsy, Bipolar Disorder. IQ

I read the other day that there has been shown to be a link between use of Depakote in pregnancy and lower IQ in the offspring of those who were on the medication. This has been suspected for some time but now has been demonstrated. Depakote has other risks and this is just one more.

Depakote is an anticonvulsant medication used to treat seizure disorders. It also was the third medication after Lithium and Tegretol to be approved by the FDA to treat bipolar disorder and for years has been one of the mainstay treatments for this disorder. Depakote is a good example of the difficulty with medication treatment for bipolar disorder in that it carries significant side effects and health risks. One problem in treating bipolar disorder is that there are four tasks; treating mania, treating depression, preventing further mania, and preventing further depression. There is no one medication good for all treatment goals and most people with bipolar disorder will end up on a combination of medication to cover all phases of treatment. This of course increases potential side effects and risks.

Depakote is a very effective antimanic agent. It also seems to do well in reducing risk of further mania, but is not a good antidepressant and may do nothing to prevent bipolar depressed episodes. It can cause side effects of sedation, significant weight gain and occasional hair loss. It is potentially toxic to the liver and liver function tests need to be monitored regularly. In addition for women there can be changes in the menstrual cycle as well as development of polycystic ovary disease. Depakote has long been known to be related to a variety of birth defects and has been avoided in pregnant women and those of childbearing age who might become pregnant. So lowered IQ in offspring is one more issue to add to the list. Unfortunately there are some women whose epilepsy can be controlled by no other anticonvuslant and there are women with bipolar disorder who cannot be stabilized enough to live in the community without Depakote.

I am writing this mostly to help people understand that treatment of bipolar disorder can be very difficult and fraught with risks. I hope that newer and better treatments will continue to be developed.

Thought for the day

Medications are neither good nor bad in themselves but every treatment carries potential risks as well as benefits.

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