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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Manic Sex Cravings

If any of my family members or anyone else that might not want to hear about my sex life because it may a) scar you or b) cause you to react negatively (judging, gossiping, etc.), please do the right thing and hit the little “X” at the top right corner of your screen now. Everyone else: Welcome to my world!

Being manic for a short period of time can be quite nice. My mood is pleasant and uplifted, I feel more articulate and creative than when I’m depressed, I have more energy and drive so I accomplish more things in shorter amounts of time, and I feel more like a “normal” human. Yes, I know that the word, “normal” is bullshit but that’s how I feel right now, with one exception: I can’t get enough sex.

I’m not usually a very sexually active person. Like, I don’t typically want to have sex more than once or twice a month (right before my period, when my lady hormones are doing their best to make me pass on my genes). When I’m very depressed, I go months without sex or any other related activity. I assume that other people go through sexual spurts (no pun intended) like I do. The difference comes with mania.

When I’m manic, which I am now, I am sexually insatiable. I have sex with my husband multiple times a night, do wilder things in bed, masturbate daily, dream about sex, daydream about sex…you get the point. This is great fun for a day or two. My husband is a good sport, dealing with the decreased sleep and the physical pain from overworked muscles and reproductive parts like a champ. After about three days, which is where I am now, it gets to be too much for both of us. But I still want more.

I cannot speak for my husband’s pain but the most common problems that I experience after too much sexy time are fatigue, painfully sensitive and swollen labia and vagina, and vaginal dryness. These things cause discomfort throughout the day and they’re downright problematic when I try to continue my sexscapades. It doesn’t stop when I’m asleep either.

When I’m manic, I have realistic dreams involving sex. I usually get to the point just before satisfaction, be it penetration or orgasm, and then I wake up. This is slightly frustrating, so I end up masturbating or having fun with my husband. He works most weekdays and Saturdays, so I’m usually on my own. No problem. This girl knows how to take care of herself.

Funny manic story: Several years ago, I was a volunteer co-leader for a scout troop in a small rural village. My fellow co-leader hosted a Pure Romance party and invited me. After the Pure Romance independent sales consultant gave her spiel and passed around a variety of gadgets, lubes, etc., she announced that the party attendees would get to choose one product that would be offered for a discounted rate at that party. When it came time to vote, nobody suggested anything so I called out the name of a butt plug. The other party attendees got strange looks of confusion and amusement on their faces. I would not have done that it I weren’t manic. Discounted butt plugs for everyone!

I have been debating writing this post because it shares some private information about my intimate life, but I love full disclosure and this blog is about my entire life bipolar, not just the things that are easy or safe to talk about. So I hope that you found this informative or at least interesting. If not, you prolly shouda hit that X in the beginning like I told you to 😉

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!

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.

Mental Health First Aid

Thanks to Kalamazoo County Community Mental Health & Substance Abuse Services (KCMHSAS) for providing me with a full scholarship to attend this training, I went to an 8-hour Adult Mental Health First Aid course yesterday afternoon. According to their website, this course “teaches you how to identify, understand and respond to signs of mental illnesses and substance use disorders. The training gives you the skills you need to reach out and provide initial help and support to someone who may be developing a mental health or substance use problem or experiencing a crisis.”

The program was initially developed in Australia and has since been adapted for use in over 20 countries, including the United States. The main goal is to equip people with the tools they need to start a dialogue about mental health so that individuals who are in crisis can get the help that they need.

“Most of us would know how to help if we saw someone having a heart attack—we’d start CPR, or at the very least, call 9-1-1. But too few of us would know how to respond if we saw someone having a panic attack or if we were concerned that a friend or co-worker might be showing signs of alcoholism.

Mental Health First Aid takes the fear and hesitation out of starting conversations about mental health and substance use problems by improving understanding and providing an action plan that teaches people to safely and responsibly identify and address a potential mental illness or substance use disorder.” The Mental Health Action Plan utilizes the following acronym: ALGEE (pronounced like the word, “algae”)

  • Action A: Assess for risk of suicide or harm
  • Action L: Listen nonjudgmentally
  • Action G: Give reassurance and information
  • Action E: Encourage appropriate professional help
  • Action E: Encourage self-help and other support strategies

In the course, we learned the signs and symptoms of depression, anxiety disorders, suicidal behavior, non-suicidal self-harm, psychosis, and substance use disorders. We did a lot of group work, where we were given hypothetical situations and asked to use the Mental Health Action Plan to determine how to help the individuals in our case studies. We learned that the action plan is non-linear, meaning that you don’t necessarily complete all of the steps in order and you don’t have to complete all of the steps in each situation.

There were a dozen individuals in the class with me and the majority of them are social workers, but there were a few people who work outside of the mental health/substance abuse field, including business professionals, a college student and so on. I think that everyone found the course to be helpful. Much of the material seemed like common sense to me, but that may be because I have lived a lot of it. I found it interesting listening to people talk about the signs and symptoms. For example, we did an activity related to hearing voices (psychosis) in which we broke into groups of three and two people had a conversation with each other while the third person whispered into one of the other people’s ears. Everyone was shocked at how distracting this is but I have experienced auditory hallucinations, so I was not very surprised. I’m glad that it helped them to better understand what an individual that is hearing voices might be experiencing.

I think that the most important activity of the day was breaking into groups of two for role playing, having a conversation with a friend that we think might be suicidal, and asking them directly, “Are you having thoughts of suicide?” or “Are you thinking about killing yourself?” This activity is required in the course because how can we help someone who is suicidal if we can’t even ask them if we are? I had never said those words out loud and it was hard but we all did it and now I know that I can. I guess I just assumed that I would be able to do it before. We learned not to ask vague questions such as, “Are you thinking about harming yourself?” or “You’re not planning on doing anything crazy, are you?” because the individual may not see suicide as harmful or crazy. We need to be very direct. If the person says “yes,” there are four follow-up questions to ask:

  1. Do you have a plan?
  2. Have you decided when you would do it?
  3. Have you collected the things you need to carry out your plan?
  4. Do you have another plan?

I’m going to share two crisis resources here.

  • The National Suicide Prevention Lifeline is 1-800-273-TALK (8255). It is “a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week.”
  • The Crisis Text Line is a 24/7 anonymous service for anyone experiencing any kind of crisis. Text 741741 or message them on Facebook and you will be connected to a trained counselor. If your cell phone plan is with AT&T, T-Mobile, Sprint, or Verizon, texts to 741741 are free of charge. If you have a plan with a different carrier, standard text message rates apply.

We covered a lot of material throughout the day, but we didn’t have to try to memorize everything because we were given a copy of the book, “Mental Health First Aid USA” to keep. It’s full of information about mental health conditions, plus statistics and vetted resources. KCMHSAS also provided us with a detailed resource list specific to our county.

If you’re able to attend a Mental Health First Aid training, I highly recommend it. Did you know that 19.6% of American adults (1 in 5) have a mental disorder in a given year? This is equivalent to 45.6 million people. These types of disorders can have a huge impact on their education, work, relationships, and health. Early intervention can greatly reduce the impact and first aiders can make a big difference by helping individuals that are in crisis to have their needs met. Can you imagine what the world would be like if we had as many people trained in Mental Health First Aid as we do in First Aid and CPR?

Writing Your Own Story

Last Saturday, I attended a workshop called “Narrative Medicine: Unpacking and Authoring Our Stories” at Kalamazoo College’s Arcus Center for Social Justice Leadership, facilitated by the Icarus Project. It was geared particularly towards individuals with mental illness. We discussed labels, who we get them from, how they are used, and how we can change the way that our personal stories are told in order to better represent us.

I have been rapid cycling between depression and mania for the past several months, something which I do not normally do. As a result, I have not taken the best care of myself and I have been isolating myself because I don’t want people to see me this way. I know that isolating is a terrible idea. Anyway, attending this workshop was a big step for me and I’m glad that I went. Although I didn’t brush my hair or shower, I did put on a nice outfit. I didn’t talk to many people because I’m experiencing confused speech and self-consciousness, but I did contribute to the group discussions.

First, we looked at the labels that we have been given during our lives. The facilitator asked us to raise our hands when we heard a label that we have either been given or that we personally identify with. Some of the labels: anxious, depressed, too sensitive, moody, difficult, dramatic, complicated, angry, irritable, aggressive, autistic, bipolar, troublemaker, irresponsible, flaky, lazy, borderline, paranoid, antisocial, immature, shy, broken, clingy, needy, and narcissist. Just about everyone in the room raised their hand for “anxious,” and the facilitator listed three different interpretations of anxiety. Her point was that there is more than one meaning for the word.

Next, she asked us to write a list of our personal labels and include where we got them from/who gave them to us. I would like to spend some more time on this, but I found the activity to be eye-opening. A lot of the labels associated with my mental illness were given to me by my family and peers when I was young. I was told that I was moody, too sensitive, bipolar, antisocial, and shy early in my life. Some labels were given to me in my adult life by medical professionals, significant others, co-workers, and peers: anxious, irritable, lazy, clingy, needy, flaky, depressed. Others are core beliefs that I attached to myself: broken, difficult, dramatic, complicated.

After taking some time to write these things down, we came together as a group to discuss our thoughts. I shared that the majority of my labels were given to me when I was young. The facilitator asked if I still identify with them (I do). This is something that I will ruminate over. Other thoughts from the group:

  • Many of us didn’t list any “positive” labels.
  • There’s power in labels. They control our behaviour. We eventually believe them even if they’re not true to us.
  • We may be quicker to internalize labels due to certain circumstances.
  • Can we escape labels? Who can do this? Some are easier to drop than others.
  • Powerful people label others despite their lack of personal understanding.
  • Being called “needy” by your significant other stifles your expression of love.

Next, we learned that nobody is capable of telling your story better than you. The facilitator read Mary’s story. The story described Mary’s physical, medical, financial, environmental, family, educational, mental, social, and employment situation. Here’s Mary’s full story: Mary’s family has lived in chronic poverty since the sources of employment in her rural town were closed down and most people in town lost their main source of income. Therefore, Mary has been poor all of her life. Despite the lack of wealth, Mary’s family is very loving and supporting. They make a point to get together at least twice a week and they share a meal, watch a movie, have conversations, or play board games. Mary’s town was deeply impacted by environmental trauma. For most of her life, Mary drank poisoned water that has given her a chronic illness. Because of lack of resources, Mary is not able to get the medical help she needs. She missed school so much that she dropped out of high school. This made Mary very lonely and depressed. Mary was embarrassed and started progressively isolating from her peers until she hardly had and friends left. Mary spends her days with her nieces, whom she enjoys very much, her next door neighbor, or her pets. Because of the unpredictable nature of her condition, she is not able to remain employed. Mary has been unemployed for the last decade. She is very angry about her lack of ability to hold down a job because of medical reasons and often lashed out at employers and co-workers. Mary eventually stopped leaving her house except for a few social outings every week. Mary has been receiving social benefits that allow her to meet basic food and housing needs.

Then, the facilitator read the town mayor’s version of Mary’s story. The mayor wants to make budget cuts to social services because he thinks that people are lazy and abusing the system. The mayor’s version of the story only included the facts that Mary has been poor all of her life, she dropped out of high school, has been unemployed for the last decade, previously lashed out at employers and co-workers, and has been receiving social benefits that allow her to meet basic food and housing needs. The mayor’s story doesn’t paint the full picture. Mary’s doctor has another version. After listening to the exact same story from Mary, they write down that she has been poor all of her life, has chronic illness, dropped out of high school (which made her lonely, depressed, embarrassed), isolated from her friends until she barely had any left, is unemployed and angry, lashed out at employers and co-workers, and has stopped leaving her house. Again, this is not the whole story. Finally, the facilitator read Mary’s rich uncle’s version of Mary’s story. Mary is struggling financially, but her uncle doesn’t want to help her because: Mary’s family is very loving and supporting. They get together at least twice a week to share a meal, watch a movie, have conversations, or play board games. Mary spends her days with her nieces, whom she enjoys very much. She also spends time with her next door neighbor and her pets. She goes on social outings every week and she has been receiving social benefits that allow her to meet her basic food and housing needs.

This last section really stuck with me because I have seen firsthand what happens when someone else tells my story. I am the only person that can tell my full story, and the first step to doing so is to examine which labels are attached to me and determine whether or not they serve me.

Finally, we discussed ways to reclaim our personal narratives. Here are a few things that we came up with:

  • “My existence is resistence.” Just living your life.
  • Being seen in public spaces.
  • Using our voices (refusing to be silenced).
  • Finding/Creating/Supporting safe spaces, where you have permission to be fully yourself unconditionally.
  • Allowing ourselves to be vulnerable (within a safe space) in order to be true to ourselves and inspire others to do the same.
  • Finding/building community and standing together.
  • Art expression (shared is especially powerful).

The Icarus Project

“The Icarus Project is a support network and education project by and for people who experience the world in ways that are often diagnosed as mental illness. We advance social justice by fostering mutual aid practices that reconnect healing and collective liberation. We transform ourselves through transforming the world around us.” (quoted from their website)

I was not familiar with the Icarus Project prior to this workshop, but I’m happy that I discovered them. The workshop gave me a lot of things to think about regarding my personal situation, and I like that they provide great resources such as publications and handouts on their website.

The Arcus Center for Social Justice Leadership 

“The ACSJL is an initiative of Kalamazoo College whose mission is to develop and sustain leaders in human rights and social justice through education and capacity-building.” (quoted from their website)

I have found the Arcus Center to be a safe space that offers enriching social justice leadership workshops. Besides this event, I attended a workshop on self-care for social justice leaders and a film screening/discussion related to human trafficking, both of which provided me with a wealth of knowledge and resources. (Delicious) meals are usually served at their (free) workshops, which are listed on their Facebook page and website. Please note that you must register in advance in order to eat. I subscribed to their mailing list so that I don’t miss any announcements.