Gary J. Kennedy, M.D., Montefiore Medical Center
Question: How is divalproex (Depakote) used in the treatment of bipolar disorder, and what are the side effects and risks?
Answer: Divalproex is a mood stabilizer, an anticonvulsant, or an anti-seizure medication. It's used for both the bipolar mania and for depression, but it takes a while to become effective. Therapeutic levels need to be drawn so that you make sure that there's the right amount of divalproex in the patient's blood -- not too much, not too little.
If divalproex level is too high, it can cause inflammation of the liver. So typically when blood is drawn to establish the therapeutic level, it's also important to make sure that there are no evidence of liver inflammation at the same time.
The other curious effect of divalproex is that it can increase the blood levels of other medications by competing for metabolism in the liver. And it's the liver where the metabolism of divalproex and a number of other medications occurs.
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