Depakote and Hair Loss

Did you know that Depakote (divalproex sodium) can cause hair loss? I have been on the drug for years and did not learn this fact until Tuesday, when I attended a second opinion psychiatric appointment at the University of Michigan.

I have been losing an alarming amount of hair on a daily basis for the past year. I told my primary care provider and the psychiatric nurse practitioner who manages my medications for bipolar disorder, but neither of them seemed concerned or told me that it is a side effect of Depakote. It’s common for 15+ full strands of hair to come out at a time when I wash my hair, comb it, or run my hand through it. I used to have lots of hair, but now it is average in quantity and more comes out every hour.

According to the Mayo Clinic:

Divalproex sodium is used to treat certain types of seizures (epilepsy). This medicine is an anticonvulsant that works in the brain tissue to stop seizures.

Divalproex sodium is also used to treat the manic phase of bipolar disorder (manic-depressive illness), and helps prevent migraine headaches.

I see that “hair loss or thinning of the hair” is listed as a more common side effect that usually doesn’t require medical attention. I’m not sure how many people would be okay with this side effect, but I am not. The following statistics can be found in “Dose-dependent valproate-induced alopecia in patients with mental disorders,”which is published on the National Institute of Health website. [1] Note: alopecia is the medical term for hair loss.

  • “A prospective study of 78 subjects who were receiving valproate found that hair loss occurred in 6% of patients.” [2]
  • “When used as mood stabilizer therapy, up to 12% of patients who are receiving valproate experience temporary alopecia.” [3]
  • “Valproate can result in dose-dependent alopecia in up to 12% of patients, including up to 28% of patients who are exposed to high valproate concentrations.” [4]
  • “A double-blind, concentration-response clinical trial of divalproex sodium monotherapy reported that alopecia occurred in 4% of patients in the low plasma valproate group (25–50 μg/ml), compared to 28% of patients in the high plasma valproate group (85–150 μg/ml).” [5]

Basically, the article argues that, “alopecia may develop in patients with chronic exposure to high plasma concentrations of valproate,” and it “resolved in all cases after dose reduction or treatment discontinuation.” Here’s another scholarly article on the subject. An article published in 2011 in Current Psychiatry states that:

Hair loss appears to be dose-related and may be more common in women than in men. Usually patients will report gradual but steady hair loss, commonly beginning 2 to 6 months after initiating treatment. Complete hair loss is rare and new hair growth typically begins approximately 2 to 3 months after alopecia onset.

The article takes it a step further, explaining that:

Valproate can cause telogen effluvium, a non-scarring form of alopecia that occurs by precipitating the follicles into a premature rest phase.

In addition to reducing the patient’s dosage (when feasible), the author recommends being gentle on hair (avoiding harsh chemicals or styling tools), taking the drug with food (encourages proper absorption of nutrients that help with hair growth), and supplementation with biotin, zinc, and selenium. [6]

So, I’m getting my bipolar ass off of this drug with the help of my new psychiatrist. There are a number of other side effects that I discovered on the Mayo Clinic’s website that I also experience: occasional swelling of the feet, confusion, cough, joint pain, mental depression, nervousness, pinpoint red spots on the skin, quick to react or overreact emotionally, rapidly changing moods, tightness in the chest, trouble sleeping, changes in patterns and rhythms of speech, clumsiness or unsteadiness, racing heartbeat, feeling warm, redness of the skin on the face, frequent urge to urinate, swollen and inflamed skin lesions, low energy, pounding in the ears, restlessness, seeing and hearing things that are not there, slurred speech, sweating, swollen joints, trouble with speaking, continuing ringing noise in the ears, loss of memory, weight gain, back pain, dry eyes, dandruff, dry skin, and earache. [7] Yeah, NOPE.

I bought a “Hair, Skin, & Nails” supplement with biotin, selenium, and zinc in it and I am tapering off the Depakote. I’ll let you know if my hair stops falling out.

References

  1. Takashi T , Hidekazu G, Tadashi Y, Katsuya T, Kenji S, Yukinao K. Dose-dependent valproate-induced alopecia in patients with mental disorders. Indian Journal of Pharmacology. 2015 Nov-Dec; 47(6): 690–692.
  2. Calabrese JR, Markovitz PJ, Kimmel SE, Wagner SC. Spectrum of efficacy of valproate in 78 rapid-cycling bipolar patients. Journal of Clinical Psychopharmacology. 1992;12(1 Suppl):53S–6S.
  3. 4. McKinney PA, Finkenbine RD, DeVane CL. Alopecia and mood stabilizer therapy. Annals of Clinical Psychiatry. 1996;8:183–5.
  4. Mercke Y, Sheng H, Khan T, Lippmann S. Hair loss in psychopharmacology. Annals of Clinical Psychiatry. 2000;12:35–42.
  5. Beydoun A, Sackellares JC, Shu V. Safety and efficacy of divalproex sodium monotherapy in partial epilepsy: A double-blind, concentration-response design clinical trial. Depakote Monotherapy for Partial Seizures Study Group. Neurology. 1997;48:182–8.
  6. Shailesh J. Valproate-induced hair loss: What to tell patients. Current Psychiatry. 2011 November;10(11):62-62.
  7. (2017, March 01). Divalproex Sodium (Oral Route). Retrieved from http://www.mayoclinic.org/drugs-supplements/divalproex-sodium-oral-route/description/drg-20072886 on 2017 July 21.
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Naming Your Feelings

In everyday society, I have learned that when most people ask, “How are you feeling today?,” they don’t really want to know the truth (or at least the full truth) so “I’m fine, how are you?” is our automatic response, which is often a lie and deflects the question away from ourselves and onto the other person. I am guilty of this and find it problematic for a number of reasons, mainly that I feel “fake” when I don’t answer truthfully/fully and that I think that this action doesn’t support good emotional health.

I don’t think that I need to explain why the response leaves me feeling fake when I use it, so I’ll dive right into the emotional health bit. If you have ever been to talk therapy, you know that the first question that is asked of you every time you visit is, “How are you feeling today?” In this situation, the therapist wants an honest answer from you and “I’m okay,” “Fine, thank you,” “Not good,” and other vague replies usually don’t cut it. For instance, I tend to say “I’m feeling okay,” at which point my therapist asks me “What does that mean? What feelings do you identify with right now?” The first time that a therapist asked me this and wouldn’t give up, I must have looked lost because I have a hard time putting a name on my feelings. Luckily, this particular therapist was quite resourceful. She dug around in her file cabinet for a few minutes, found a handout, and made me a copy of something very similar to this:

How Do You Feel
Image credit: https://s-media-cache-ak0.pinimg.com/564x/07/76/24/0776245ef14968c0b0f6074553ca3000.jpg

As I sat across from my therapist, I felt bad about myself because I had a difficult time naming my feelings even with the help of this handout. The official word for this condition is alexithymia, and this is what Wikipedia teaches us about it:

…a personality construct characterized by the subclinical inability to identify and describe emotions in the self. The core characteristics of alexithymia are marked dysfunction in emotional awareness, social attachment, and interpersonal relating. Furthermore, alexithymics have difficulty in distinguishing and appreciating the emotions of others, which is thought to lead to unempathic and ineffective emotional responding. Alexithymia occurs in approximately 10% of the population and can occur with a number of psychiatric conditions.

While my therapist and other mental health professionals never offered me this label, which I find morbidly ironic, she had me bring my “How Do You Feel Today?” handout to every session. I would look at each face at the beginning of our meeting and try to decide if that was how I felt. There were at least a handful of faces/words on my list like demure, loaded, purlish, and surly that I simply couldn’t relate to and my personal list of feelings was extremely limited (happy, sad, angry, bored, disappointed, frustrated, lonely, overwhelmed, scared, hopeful, proud, tired, and worried). Eavesdropping was also on the list, which really confused me. Isn’t that an action, not a feeling? I mean, you can feel like eavesdropping on someone, but that’s an urge to take action. I digress. My original handout, with my added list of feelings:

How Do You Feel Today?

A Facebook friend posted something today that made me start thinking about all of this:

Emoticons
Emoticons explained. Credit: Shira Dotnet.

Lightbulb moment! I have been frustrated with myself because I always use the same boring emoticons: 🙂 & <3. I realized today that it’s probably because I have a hard time matching the expression to the feeling! I saved Shira’s post. I don’t really care if I use emoticons on my personal accounts, but I have a small business and I want to use them more in those posts.

Almost a decade later, I choose not to attend therapy regularly anymore but I continue to try to get more in touch with my feelings in terms of putting a name on them. I just found the term, alexithymia, today and I am 100% certain that I have it, as I have issues with social attachment, interpersonal relating, and emotional responding too. I plan to learn more about it. After reading a little, I found out that it is not considered to be a mental disorder in the DSM-IV, but rather a personality trait that can influence mental health. The cause is unknown. Also from Wikipedia:

A person’s alexithymia score can be measured with questionnaires such as the Toronto Alexithymia Scale (TAS-20), the Bermond-Vorst Alexithymia Questionnaire (BVAQ), the Online Alexithymia Questionnaire (OAQ-G2) or the Observer Alexithymia Scale (OAS).

Do you struggle with identifying feelings? How do you cope? Do you have any tips for becoming more aware of your feelings? Please share!

Le Chat Domestique
The Domestic Cat and His Character. I purchased this poster while strolling along the Seine River in Paris in 2005.

My Psychiatric Drug List

It’s important to keep track of your own psychiatric history drug because you will be asked about it in the future and it is much easier when you have everything written down. I wasn’t smart enough to do this from the beginning, but I requested copies of my medical records later when I was applying for Social Security Disability. This is a running list that I will update as needed.

Antianxiety

  • Ativan 1mg BID (10/07-11/08? check BHR records)
  • Celexa
  • Klonopin 0.25mg, 0.5mg, 1mg PRN (7/05-

Antidepressant

  • Effexor XR 75mg, 150mg (12/03-8/04)
  • Lexapro 10mg, 15mg, 20mg (8/05-11/08? check BHR records)
  • Pamelor HCL 10mg
  • Remeron 15mg
  • Trazodone HCL 50mg
  • Wellbutrin 150mg, 200mg, 300mg (8/04-11/08? check BHR records)
  • Zoloft 100mg (3/03-12/03)

Antimanic

  • Depakote ER 1500mg, 2000mg
  • Lithium ER 300mg (am) + 450mg (pm), 400mg BID, 450mg BID, 1200mg (10/07-11/08? check BHR records)

Atypical Antipsychotic

  • Abilify 5mg, 10mg, 15mg, 20mg (2/06-4/06, 6/06-8/07, 2/08-11/08? check BHR records)
  • Latuda 20mg
  • Geodon 20mg
  • Seroquel XR 150mg, 200mg, 300mg

Mood Stabilizer

  • Lamictal 25mg (2/06-2/06)
  • Topomax 25mg, 50mg, 100mg, 150mg, 200mg, 50mg (am) + 150mg (pm) (3/06-

Eugeroic (Wakefulness-Promoting)

  • Provigil 100mg, 200mg (10/06-4/07)

Central Nervous System Stimulant

  • Ritalin 5mg (6/07-
  • Concerta 18mg (5/07-

Sedative

  • Ambien 10mg, 12.5mg (5/05-7/05, 6/06-7/06, 12/06-2/07, 5/07-)

Herbal & Over The Counter

  • Melatonin
  • Vitamin D3 2000 IUs

 

bold = possible personal gene-drug interaction (based on my GeneSight test results)

Falling Through The Cracks Update

If you read my post Falling Through the Cracks, you know how frustrated I have been with the process of getting a second opinion. Good news! After two months of waiting, my appointment with a psychiatrist at the University of Michigan is scheduled for July. Fingers crossed that this doctor-patient relationship is better than my current situation and that I am introduced to new treatment options aside from medication!

Psychiatric Drugs That Impair Memory

I scored a copy of Martha Stewart’s book Living the Good Life: A Practical Guide to Caring for Yourself and Others for fifty cents at Salvation Army last month and I just sat down to read it. Part 1 features a section on brain health and there’s a big list of medications that have been shown to affect memory. There are over 15 classes of drugs listed, from analgesics (pain killers) to steroids. I would like to share the relevant psychiatric drugs here in the name of informed consent.

Antianxiety Drugs

  • alprazolam (Xanax)
  • diazepam (Valium)
  • lorazepam (Ativan)
  • oxazepam (Serax)
  • temazepam (Restoril)
  • triazolam (Halcion)

Antidepressant Drugs

  • amitriptyline (Elavil)
  • imipramine (Tofranil)

Antipsychotic Drugs

  • chlorpromazine (Thorazine)
  • haloperidol (Haldol)
  • thioridazine (Mellaril)

Hormones

  • levothyroxine sodium (Synthroid)

Seizure Drugs

  • carbamazepine (Tegretol)
  • gabapentin (Neurontin)
  • valporic acid (Depakote)

Sleep Drugs

  • zolpidem (Ambien)

I have personally taken a number of these drugs as well as several of the antibiotics, antihistamines, decongestants, anti-nausea drugs, steroids, pain drugs, and hormones and I am certain that long-term use of the psychiatric drugs has caused memory problems. I did not have memory issues until college, which is when my prescriber put me on a bunch of different psych meds. I am 34 years old now and I have significant memory issues. What about you? Have psychiatric drugs impaired your memory? Did you know about this side effect before you agreed to take the drug? How does this make you feel? I am mad (to say the least). I intend to research when it was determined that each of the drugs that I took caused memory problems and, if I was not properly warned before taking the drug, file claims against the makers of the drugs.

My Experience with Geodon

Ziprasidone (the generic form of the antipsychotic drug Geodon) was prescribed to me in the spring of this year because I was experiencing a long-lasting bout of moderate to severe bipolar depression with episodes of rapid cycling bipolar and intrusive suicidal thoughts. Ziprasidone is used to treat acute manic or mixed episodes associated with bipolar disorder and to treat symptoms of schizophrenia. It is also used as a maintenance treatment of bipolar disorder when added to lithium or valproate (Depakote). I took the medication as prescribed (1 20mg capsule by mouth at bedtime with food) along with my other meds (depakote extended release, trazodone, metformin) for four days before I had to stop. Geodon caused me to wake up in the middle of the night every night and have strange thoughts. More specifically, I wanted to go outside and run as fast as I could through the woods behind our house. My sleep was disturbed despite taking trazodone at night for sleep. Complete prescribing information can be found here. FDA (U.S. Food & Drug Administration) can be found here.