Medication guide

Valproate (Depakene)

What is valproate?

Valproate is known as Depakene in Japan (デパケン on Japanese packaging; slow-release forms are sold as デパケンR and セレニカR), as Epilim in the UK, and in the US mainly as the closely related Depakote. It's a mood stabiliser that is also an epilepsy medicine: it steadies overactive brain signalling, settling the highs of mania.

How is it different from other mood medicines?

Works in the acute phase: it is approved for treating a manic episode itself
Three fields of use: mania, epilepsy, and migraine prevention
Easier day-to-day rules than lithium: no strict fluid-and-salt routine, and blood levels don't always need checking
Standard and slow-release forms: the slow-release form needs fewer doses a day

What is it used for in Japan?

Mania in bipolar disorder
Epilepsy (several types)
Preventing migraine attacks

How does it help?

It steadies overactive brain signalling, settling the elevated, driven state of mania. Blood tests may be used to check the level, especially when the dose is changed or the effect isn't what was expected.

What should I tell my doctor before starting?

A few situations rule it out entirely; your doctor will choose something else if any of these apply:

Severe liver problems
Carbapenem antibiotics (a hospital-used antibiotic family); the combination isn't allowed
A urea-cycle disorder (a rare inherited metabolic condition)
Pregnancy, when valproate is used for migraine (and for any use, pregnancy needs the section below)

And tell your doctor first if any of these apply; these usually just need adjustments or a closer eye:

Any liver problems, now or in the past
Blood thinners such as warfarin, or regular aspirin
Other epilepsy or psychiatric medicines (levels can interact)
A family history of a urea-cycle disorder or of unexplained death in infancy, or a past unexplained brain illness or coma (possible signs of a metabolic condition)
Being older
Pregnant, planning to be, or being a woman who could become pregnant (see the section below; with valproate this matters especially)

Your doctor will run liver and blood tests, especially in the first six months, and may check the blood level of the medicine and the ammonia level.

How do I take it, and what if I miss a dose?

Valproate is taken two or three times a day with the standard tablets, and less often with the slow-release forms; slow-release tablets are swallowed whole (don't crush or chew).

If you miss a dose: take it when you remember, unless the next one is close; in that case just skip it. Never take a double dose to catch up
Take it at the same times each day: steady levels are what the treatment relies on

What side effects should I expect?

Most are mild and settle as your body adjusts, and many can be eased with a counter-medicine if they persist. Not everyone gets them.

Drowsiness: the most common
Nausea or stomach upset
A fine tremor of the hands
Weight gain, with a bigger appetite in some people
Hair thinning, in a small number of people

If anything is bothering you, tell your doctor; there's often a way to adjust.

Finally, a few things that are rare (most people never experience them) but good to know:

Yellowing of the skin or eyes, especially in the first six months: worth a prompt check, as this can point to the liver, and the routine blood tests are there to catch liver problems early
Severe stomach pain with fever or vomiting: get medical care promptly
Unusual drowsiness or confusion: worth a prompt check, as a rise in ammonia can cause this, and it is picked up on blood tests

Will I become dependent? How do I stop safely?

No; valproate isn't habit-forming. But stopping suddenly is risky in its own way: mood symptoms may return, and if it's covering epilepsy, seizures can too. Any change is made gradually, with your doctor.

Can I drive while taking it?

The Japanese label advises against driving while taking it. Valproate can cause drowsiness and slowed reactions, and for mania the label here instructs that patients on it shouldn't drive or operate dangerous machinery. Discuss your own situation with your doctor.

What about pregnancy and breastfeeding?

Valproate carries one of the strongest pregnancy warnings of the medicines on this site, so this conversation should happen before pregnancy, not after. Valproate can seriously harm a developing baby: higher rates of spina bifida and other malformations, and effects on learning and development. For anyone who could become pregnant, the Japanese label asks the doctor to explain this risk first and to judge carefully whether valproate is the right medicine, and Japan's bipolar guideline strongly recommends not using it in pregnancy. If you could become pregnant and are continuing valproate, talk with your doctor about pregnancy plans and contraception. For migraine prevention, it isn't used in pregnancy at all.

At the same time, never stop valproate suddenly on discovering a pregnancy; sudden withdrawal has real risks (relapse, or seizures if it's covering epilepsy). Contact your doctor immediately instead; switches are planned, not improvised. Breastfeeding is a separate, individual decision, and the Japanese label is less restrictive here than it is for pregnancy. Our guides to medication in pregnancy and medication while breastfeeding cover the details.