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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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.

Shameless

I started watching Shameless on Netflix about a month ago and I am halfway through season 5 already. I like it for several reasons, one of which is the excellent portrayal of bipolar disorder in both Monica and Ian Gallagher. Spoiler alert: if you haven’t watched through season 5 episode 8, you may want to skip this post for now.

I didn’t “get” Monica until the Thanksgiving dinner episode, at which time I knew as soon as she stood up from the table that she was going to do something terrible. In terms of “highs” and “lows,” I spend most of my time depressed and I tend to get suicidal. Unfortunately, I also get impulsive. As Monica and Ian show us, depressed + suicidal + impulsive = danger.

When Ian was acting strange after going MIA from the army, I wasn’t sure if it was drugs or mania but when he wouldn’t get out of bed for days, I knew.

The one thing that I would say is that my experience in psych wards was slightly different from what Monica and Ian experienced. I have been in three different wards. Two things:

  1. Psych wards have nightly “checks,” in which hospital staff look into your room at night to make sure that you are in bed, okay, and that you’re not getting into trouble. So, Monica’s nighttime sexytime with the other patient is something that isn’t likely to happen.
  2. The guard at the hospital got rough with Ian. I have never experienced or witnessed unnecessary force in a psych ward. I’m sure that it happens, but I don’t think it is common.

I’m up to the point where Ian says that he flushed his meds because they make him feel awful. If you have never taken medicine for a mental illness, you can’t possibly understand what it’s like. And you can’t understand what it’s like to live with a mental illness if you don’t have one, but this show can help you to get a feeling for it. It’s refreshing to see bipolar accurately portrayed in a show. I tried watching Homeland, a series in which Claire Danes plays a CIA agent with bipolar disorder. I thought that show did okay, but Shameless does much better. Consider watching it.

GeneSight Test: Part 1

Earlier this month, my Psychiatric Nurse Practitioner suggested that I submit DNA samples for GeneSight Psychotropic and GeneSight MTHFR combinatorial pharmacogenomic testing. What does that mean? Why would I want to do that? I’m glad that you asked! If you didn’t ask those questions in your head, feel free to move along.

According to their website,

“The GeneSight test analyzes a patient’s genes and gives healthcare providers information to help them select the medicine(s) that are more likely to work for an individual patient. GeneSight provides answers that can lead to a personalized treatment plan and faster response and remission for patients.”

They currently offer 4 tests:

  • GeneSight Psychotropic (for mood-altering prescription drugs used to treat depression, anxiety, bipolar disorder, schizophrenia, and other behavioral health conditions)
  • GeneSight Analgesic (for prescription painkillers)
  • GeneSight ADHD (for prescription attention-deficit/hyperactivity disorder drugs)
  • GeneSight MTHFR (tests how well your body can convert folic acid into its active form)

 

I decided to get tested because I have been struggling for over 16 years with finding medications that work well for me and don’t have intolerable side effects.

I have already typed out a really long blog post about my experience having the test done and my results and then I decided to break it up into manageable sections. Because who wants to stay up all night reading this? Probably not you. So, stay tuned for parts 2, 3, and maybe 4! And for now, get some sleep. Monday is going to come too early.

Falling Through the Cracks

It is so easy to fall through the cracks of the mental health system! It infuriates me. I can ramble on for hours about all of the times that I have personally felt as though I was forgotten. Today, I will share one example.

If you have been reading my blog, you know that I was pretty depressed for a significant amount of time recently. I made and attended an appointment with my psych med prescriber, a Nurse Practitioner who specializes in psychiatric medicine. I have seen him for about three years and we have a decent doctor-patient relationship, but I think that he is heavily influenced by big pharma, as many prescribers are. He tolerates my strong will and we compromise on my treatment plan, but I want to explore other options besides drugs because I have tried *so many* without success, or with side effects that aren’t tolerable. I have mentioned to him several times that I would like to see a psychiatrist at the University of Michigan Psych Department, but he always seems to change the subject and hasn’t made the referral. At this particular appointment, he brought up the GeneSight test, which I will blog about very soon, and successfully derailed the conversation. After my appointment, I realized that the referral wasn’t addressed. Again. I ended up at my Primary Care Provider’s office a few days later because I wasn’t feeling well and I mentioned that I would like to have a referral to U of M and she sent an urgent referral right then.

I ended up at my Primary Care Provider’s office a few days later because I wasn’t feeling well and I mentioned that I would like to have a referral to U of M and she sent an urgent referral right then. I really like my PCP. She takes care of business. She told me to call U of M if I hadn’t heard from them in 2 days. It has been 3 days, so I just called. My PCP’s office gave me the wrong number, so I ended up calling U of M’s Psych Emergency Department on accident, but they gave me the correct number. I’m lucky that I am functioning well right now because I have a strong aversion to making phone calls, and under circumstances in which I am very stressed or depressed, I avoid doing it altogether. Anyway, I called and they told me, without asking for any information regarding my urgent referral, that they “are full until June,” and that they are suggesting that people call back in mid-May to schedule for July. WHAT THE FUCK?! Sounds like they weren’t going to call me to let me know this, so it’s good that I called, but now I have to put this on my calendar for mid-May, hope that I am functioning enough to do it myself, and deal with scheduling an appointment at one of the busiest months of my year.  I’ll put it on my to-do list.

All of this runaround is difficult to manage on my own. I am lucky that I have an awesome PCP and a good support group. What challenges have you faced in getting mental health treatment or support? How did you overcome them?

I Found Some Hope!

Have I mentioned that I’ve been struggling with depression for the past month or so? I’m trying to avoid going to the hospital and it has been tough, but today I discovered a potentially helpful community resource.

My day started with 3 fillings at my dentist. With 2/3 of my mouth numb, plus my right eye, ear, and my nose, I sat in my car after my appointment and tried to figure out what to do for the rest of the day before dance practice. I had 7 hours to blow. I sat in my car for a good 45 minutes, basking in the sunlight on Michigan’s first warm spring day of the year and farting off my unfortunate breakfast choice, as I tried to decide whether I should drive home (a 30-minute commute) and sleep off the anesthesia or parade my crooked smile around Salvation Army, looking for deals on stuff that I didn’t need. I finally left with no plan, but then remembered that I had seen a mental health office on my drive in. I would pop in and see what they offered!

With a VERY wonky face, dental chair hair, and (probably) a faint eau de fart aroma about me, I walked into Pine Rest Christian Mental Health Services. No, I’m not Christian. But I am desperate and I would hope that my treatment wouldn’t be heavily peppered with religion. Anyway, the receptionist kindly informed me that their office only offers therapy, med management, and a substance abuse group. I’m looking for bipolar and/or depression groups and possibly partial (day) hospitalization. She made it sound as if the other local branch offered day hospitalization, so I drove there. I could have just called, but I have a stupid aversion to talking on the phone.

The next place was the same story, but they were kind enough to suggest the Elizabeth Upjohn Community Healing Center. So I drove there. This place was the same deal as the first, but with more substance abuse options, plus child therapy. Have I mentioned that every time I open my mouth to speak, the right side of my mouth and face doesn’t move? The reaction from the various people that I interacted with was pretty comical. Usually a look of slight confusion and then terror. Anyway, this time I was referred to the local DBSA  (Depression and Bipolar Support Alliance) chapter. I had to call :(. Nobody answered, but there was a message stating when their group meets (Mondays from 7-9 pm). I was really hoping to find something during the day, when my husbeast is not home with me. He works a lot of hours and I usually only get to spend 3 hours per night with him + Sunday and sometimes I see him on his day off, depending on which day that falls on.

So, feeling like I was at a road block, I got on my phone and tried to see if there was a DBSA chapter in the neighboring county. I’m not clear on the answer to that, but I stumbled across the local NAMI (National Alliance on Mental Illness) chapter, which listed several support groups in my area for family members of individuals living with mental illness (a good find, although not sure the husbeast will ever be able to do it due to his work schedule) AND I read about the Recovery Institute of Southwest Michigan, Inc.

Sorry that this story has gotten so long! Here’s the point: this sounds like exactly what I need right now. The Recovery Institute of Southwest Michigan, Inc. is a peer-run non-profit organization for individuals that are embracing recovery. There are weekly peer support groups for substance abuse, addictive behaviors, mental illness, for veterans, and for members of the LGBTQ community. There are ongoing wellness classes such as “whole health action management,” tobacco reduction, writing about recovery, meditation, yoga, and even an “open studio” time, when people can play games, play music, and share skills with each other. There is individual peer support and recovery coaching available, as well as special events and activities like computer lab, reading and writing tutoring, access to the local YMCA gym and pool, movie screenings, workshops, luncheons, and field trips. All of these resources are available to me for FREE, thanks to individuals like myself who volunteer to make the Recovery Institute work.

I picked up the March and April schedules, and I have so many good options! And all of them are during the day. I look forward to embarking on this new leg of my recovery. I’m sure that I will meet some great people and learn a lot about myself and others.

Do you participate in any groups to help you manage your mental illness? What are you doing on your own to manage your symptoms?