Reader Question: Julie, what is the difference between Depakote and Lamictal? #bipolar #schizoaffective
Great question as our bipolar world of medications can be a bit confusing. I am lucky as I was trained by a master, Dr. John Preston. For over ten years, he has taught me about psychiatric medications. So please know that what I write is my opinion, but it is based on a solid background in medications.
This is info to use with your health care team.
There are four main psychiatric disorders: Mood, Anxiety, Psychotic and Personality. Depression and bipolar disorder are mood disorders.
Bipolar disorder is what I call a garbage pail illness as it has ALL of the symptoms you find in all four categories of psychiatric disorders. The difference is that bipolar is episodic and our symptoms mix and match and come and go. This is a very unique aspect of bipolar.
If you have depression and mania, you have bipolar. It is genetic and not situational. Bipolar runs very deeply in a family tree and almost anyone with the illness can find a form of bipolar in a close relative.
There are four main types of psychiatric meds: mood stabilizers, anti depressants, anti psychosis and anti anxiety. You can also add ADHD and sleep medications to this list, but for the question regarding Depakote and Lamictial, here is what you need to know.
1. There are NO and please hear this clearly- there are ZERO medications on the market to treat bipolar disorder as a whole. The only medication used to treat bipolar disorder fully is lithium and it is a natural salt.
2. ALL manufactured, man made medications used for bipolar are used as ‘off label’ medications. This means they were created for something other than bipolar disorder and where found to actually help those of us with the illness.
3. Anti depressants are NOT a treatment for bipolar disorder as they tend to cause mania while helping a person who is depressed. This is why anti depressants can NEVER be used alone in the treatment of bipolar depression. They can be used with caution with a ‘mood stabilizer,’ but never alone.
4. The term MOOD STABILIZER is not really correct. There are no real mood stabilizers on the market. The drugs we now call mood stabilizers were created for other illnesses and then renamed mood stabilizers when it was found they helped bipolar.
5. Any medication used to treat bipolar disorder moodswings has to be careful monitored as we tend to get manic from medications that affect the brain directly – such as anti depressants and ADD meds. Yes, I am aware I am repeating myself. This is hard stuff to remember!
6. Many years ago, people with epilepsy used anticonvulsant drugs to stop epilepsy episodes and people reported that their moods were miraculously better as well! Thus, today’s ‘mood stabilizers’ are almost exclusively epilepsy drugs. Tegretol, Tripeltal, … DEPAKOTE and LAMICATAL are all anti convulsants that are used off table to treat bipolar. But, they are not all the same and many, many general health practitioners need a lot more education on this topic.
Depakote and Tegretol are used for mania. ONLY. They are not for depression. They are anti mania drugs. This means that they can help someone with bipolar greatly, but there still may be a lot of depression to contend with. These are usually used in bipolar one as they really are great at preventing mania. As with all drugs, the issues are with side effects, not the efficacy of the drugs.
Trileptal is sometimes used in bipolar mania treatment, but it’s not as common as Tegretol and Depakote.
Then there is what I call the wonder drug Lamictal. The generic is lamotrigine. This is a spectacluar and life saving drug for many people as it treats bipolar depression and for the majority of people, it doesn’t cause mania the way all SSRI drugs cause mania. It revolutionized the medical treatment of bipolar disorder, but it is often misused as people think it helps mania. It does not.
Lamictal is for bipolar depression only. Although it can help with some hypomania and can definitely help curb some milder rapid cycling, Lamictal is NOT a mania drug. So, to finally answer your question and it is a good one.
Depakote is an anti convulsant, renamed a mood stabilizer that is used only to treat mania.
Lamictal is an anti convulsant, renamed a mood stabilizer that is ONLY used to treat bipolar depression.
They are NOT interchangeable. This is why you will often see people with bipolar one on Depakote and Lamictal. People with bipolar two often have a different drug path as we live with hypomania and not full blown/psychotic mania.
Please know that you can be on Depakote alone to treat bipolar if the depression is not overwhelming.
But you cannot be on Lamcital alone to treat any form of bipolar if the mania is a problem. It is not a mania drug. Please educate our health care world on this fact. General practitioners almost always get this wrong.
Whew! But wait, there is more. Now that you have the above info, there is another set of drugs I didn’t discuss. But before I do so, here is a quiz:
1. What is the only real mood stabilizer that works on mania and depression?
2. Are there any medications on the market that were created specifically to treat bipolar disorder?
3. Does Lamictal treat mania?
Answers: Lithium,no and no!
Next, the truly wondrous but really terrible in terms of side effect drugs called anti psychotics.
By the way, when someone says they hate psych drugs, I like to challenge this statement. Why would we hate drugs that save millions and millions of lives? What we hate are the side effects. There really is a difference. People don’t hate Depakote. It works to prevent mania. It’s a miracle. What they hate is the weight gain, etc. Let’s get clear when we talk about meds. Now, the biggies- the anti psychotics. They are revolutionizing our bipolar world.
Anti psychotics were introduced in two phases called first and second generation mediations. The first generation started in the 1940s with the creation of Thorazine. People hate this drug. I don’t. Thorazine was and still is a miracle. It stops psychosis for many people. Other drugs followed such as Trilafon and Haldol. People hate these as well. But do we really hate these drugs? No. We hate the side effects and believe me, the side effects of Thorazine are legendary. I have been on Trilafon and Haldol. It’s not pleasant. But they worked.
In the 70s, atypical or second generation anti psychotics were introduced. The biggest name here is Zyprexa from the 1970s.
Why does this matter for people with bipolar? First, because many of us actually deal with psychosis, but the real breakthrough came when hospitals realized that anti psychotics are also anti mania drugs. So like Depakote and Tegretol, anti psychotics such as Zyprexa, Seroquel, Risperdal and now Abilify and Latuda were used much more for people with bipolar instead of them being seen only as schizophrenia or psychotic disorder drugs.
They changed our lives. This is why many, many people with bipolar one are often on anti psychotics.
Once again, we say we hate these drugs. The anti psychiatric movement vociferously hates these drugs, but I have a different opinion. I LOVE these drugs. They stop mania and psychosis. What we all hate is side effects. That is where we need a revolution. There are no natural treatments for those of us big time bipolar, especially if a person also has a psychotic disorder as I do.
Then, another miracle happened- and yes, I use the word miracle for these drugs. It was found that anti psychotics such as Abilify also helped many people with bipolar depression. A drug for depression that doesn’t cause mania, but actually helps mania as well. That is a miracle. Too bad about the side effects- it’s always a trade off.
I believe in limited/lowest dose possible use of medications with a strong management plan. I would not be alive without the judicious use of medications. Trying to treat bipolar disorder, schizoaffective and schizophrenia without some kind of medication help is nigh on impossible. Sure, a few can do it, but the majority of us cannot. It is rare to find someone with schizophrenia who can manage the illness without some form of help from anti psychotics.
People with bipolar and schizoaffective need more education around these serious medications. We need to advocate for medications with less side effects. That is where the main problem lies, not with the efficacy of the drugs.
Now, you can answer the question yourself- What is the difference between Depakote and Lamictal?
