Brief Answer: there is no research evidence of such risk Detailed Answer: hello, welcome to hcm! If a person who is bipolar but doesnt have any history of seizures (history of drug abuse, head injury) in past, tapers off his sodium valproate, then there is no research evidence supporting the risk of seizure occurrence in him. So, ideally, under normal circumstances one can safely and slowly withdraw the drug. however, as you must be aware of -- one must keep a check on symptoms of bipolar disorder while carrying out the tapering process. hope the reply is helpful for you Wish you good health! Please ask more questions for any clarification if needed. Dr. Manisha Gopal MD Psychiatry

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Brief Answer: donot rely on test result completely Detailed Answer: Hello, Psychiatry is one of the toughest and most enigmatic field, any test done in this area is only supportive in nature and can never be diagnostic. Moreover, almost 60-70% of the symptoms overlap across various disorders and that is the biggest reason that only and only through a detailed clinical interview the diagnosis is made. However, you may go for an online test--the Mood Disorders Questionnaire and the Bipolar Spectrum Diagnostic Scale and XXXXXXX questionnaire. But it will be my sincerest advice that donot wholly depend on its results. Psychotherapy is very effective in certain psychiatric disorders, and in depressive phases and maintenance phases of bipolar as well. But is you want it as the only modality to treat bipolar then it is not effective at all. The manic phase of bipolar disorder is a very high state and associated with delusions and over activity, the brain is full of running, random thoughts. In this phase one cannot even talk to the patient calmly, so how can any therapy work? Moreover, if the mania is not controlled in time, a single episode of bipolar further increases the tendency of neurons to fluctuate...thereby increasing the chances of new episodes. I know that taking meds is the biggest and worst task in this world...but we do eat and sleep and do several things daily...because we consider them essential. So, accepting and telling oneself that this too is essential really helps. Do not fight with yourself, if someone's brain needs it, then it is ideal to listen to demand of ones body and follow it. I hope you find this useful. Please ask more questions for clarification. Dr. Manisha Gopal MD psychiatry

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Brief Answer: side effects are common, can shift to other drugs Detailed Answer: Hello, There are certain common side effects of depakote - weight gain, acne, hair problems, lipid profile and sugar level disturabance, fatty liver and metabolic syndrome and others too. Everyone donot develop side effects, many of my patients have been on this drug from past several years ( free of new episodes of bipolar disorder) with all tests in normal range till date. By getting a regualr walk daily, checking what you eat [low fat and sugar] one can keep fit. I can understand your point --you are young & from the side effects mentioned above anyone would want to avoid this medicine for long run. So, a balanced approach should be made in which you also remain well and free of new episodes of bipolarity and take an acceptable drug. There are some safer and comparatively healthier mood stabilizers available E.g. oxcarbazepine, lithium ( shares some side effects of depakote), olazapine etc.. You can discuss about these choices with your treating doctor and gradually shift to one of these. Getting blood levels of mood stabilizers done at regular intervals along with routine liver, kidney, sugar and lipid profile ( thyroid test with lithium) help to attend and check any disturbance in its begining. I hope you find the answer helpful. Please do ask more queries of there is any doubt. Dr. Manisha Gopal MD Psychiatry

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Brief Answer: changing depakote to oxcarbazepine will help Detailed Answer: hello and welcome to hcm! Your hands are shaking due to depakote and not because of zyprexa ( olanzapine). Tremors are also a side effect of depakote but usually seen late, seems that your body is showing side effcts to this drug early. Do not worry, this can be handled. We will gradually reduce depakote by 250mg a week and finaly stop it. ## I dont know how many episodes you have had prior to this, ( it is not mentioned anywhere). So, taking this to be the first episode, the drug ( mood stabilizer) should continue for at least three years. While tapering down depakote, you should build up oxcarbazepine ( we should change the medicine --depakote to oxcarbazepine). It is required that you take a mood stabilizer. ## Taking a low dose of depakote is not suggestible as-1. can also produce tremors 2. and a low dose might not be adequately effective in controlling occurance of fresh episode). I start with a dose of 300mg twice a day (of oxcarbazepine) and grdually build it upto 900-1200mg. The initial few days one can feel sleepy but this effect weans off in time. There is no problematic side effect (unlike depakote has)with this drug. So, try to continue this. This will keep you safe from any fresh episode. Zyprexa can be safely tapered and stopped (2.5mg at a time ) after a month from now if you keep fine. It is advisable to get the blood level of oxcarbazepine done every three to six months. Along with this one is required to get blood counts, liver, kidney and lipid profile in start of the new drug and every 6 months there after. I wish you good health. Please ask if there is any doubt Dr. Manisha Gopal MD psychiatry

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Brief Answer: please check your diagnosis as below Detailed Answer: Hello, There are certain major doubts which need to be addressed here. Please read the following and see what you have.. A. For a person to be diagnosed of bipolar he has to have either: 1. two episodes of mania or 2. one episode of mania and one of depression. B. Only one episode of either mania or depression dosent make you a bipolar. In your first question you said that you are a non epileptic bipolar...? C. If this is yout first episode, with symptoms like- over activity, over confidence, elated mood, high energy level, lack of need to sleep, demanding and domeenering attitude, desire to spend or distrubute money, over socialization, and may be suspiciousness and thinking yourself to be God/ having extreme/ special powers...then we diagnose of mania. D. We treat mania with a simple antipsychotic like - olanzapine, and sometimes we need to add a mood stabiliser like depakote ( in extreme cases) The usual duration of treatment of an uncomplicated mania is 3-6months. E. But the treatment of bilolar disorder is long. So, if this is your first episode of life - then it is not a bipolar disorder & one can have high hopes that your meds will stop soon. F. Taking this to be your first episode- and that you are 100% back to normal now, depakote can be tapered and stopped. As mentioned in last answer, start with reducing 250mg at a time, wait for a week or so, and further reduce another 250mg and thereby keep on reducing and stop it. G. Continue with zyprexa for a month or two more, this is important for the neurons to stabilize sufficiently. Do not hurry to stop zyprexa. H. Stopping depakote will remove your complaint of tremors. I. If this is your first episode of life, then you need not shift to oxcarbazepine also. No mood stabilizer is needed in uncomplicated and usual episode of mania. I hope this clears some more doubts. If there are still some doubts bothering you, please ask, i will try to help you. Dr. Manisha Gopal MD Psychiatry

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Brief Answer: donot worry please, it wil be fine Detailed Answer: Hello Usual aggressive behavious of youngsters are not taken to be related to bipolar. To diagnose mania the episode should last for a week or more OR should be severe enough to neccessiate admission. If this hadnot been the case with you and your parents did not felt you to be that severe intensity- then the previous ones should not be counted in episode list. They however tell that you are aggressive and provocative by nature. The latest one is a manic episode and so needed meds to calm you down. Now coming to managment-- one should consider both your personality and the episodes. If i had been treating you, i would definitely want that you should take zyprexa for some months more. You can taper and stop depakote ( as it is giving you disturbing side effects and there is no point in taking a drug which is so evidently and cosmetically harmful at even a low dose). I will definitely be avilable to help you with the drugs and illness. Please donot fear so much, you are ok now and if you will try religiously then you might never get another episode ever. It is good to start going for a walk; Avoid all types of stimulants- alcohol or ciggrettes all your life; Eat more of green leafy vegetables ; Try to get at least 6-7hrs of sleep daily at night( this is one of the most important way. to beat fresh episodes of bipolarity); Try to avoid taking over stress in life...difficult to do, but with practice one can do this. I hope you understand that you should take zyprexa for some more time and can reduce and stop depakote. You may discuss this with your treating doctor. Dr. Manisha Gopal MD Psychiatry

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