Medication guide

Valproate (Depakene)

What is valproate?

Valproate is known as Depakene in the United States and Japan (デパケン on Japanese packaging; a slow-release form is sold as セレニカR), and as Epilim in the UK (the US also has the closely related Depakote). It's a mood stabiliser that is also one of the longest-used epilepsy medicines: it steadies overactive brain signalling, evening out the highs of mania.

How is it different from other mood medicines?

Fast to act on mania compared with many alternatives, which matters in an acute episode
Three fields of use: mood, epilepsy, and migraine prevention, all long established
Easier day-to-day rules than lithium: no strict fluid-and-salt routine, and a wider comfort zone on blood levels
Flexible forms: standard and slow-release, once or twice daily

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 and keeping mood more even. Blood tests are used from time to time to keep the level in a comfortable range.

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, or a bleeding tendency
Other epilepsy or psychiatric medicines (levels can interact)
Pregnant, planning to be, or being a woman who could become pregnant (see the section below; with valproate this matters more than with any other medicine on this site)

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

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

Valproate is taken once or twice a day depending on the form; slow-release tablets are swallowed whole (don't crush or chew).

If you miss a dose: just skip it if the next one is close. Never take a double dose to catch up
Take it consistently; steady levels are what make it work

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.

Nausea or stomach upset: mostly early; taking it after food helps
Drowsiness
A fine tremor of the hands
Weight gain, with a bigger appetite in some people
Hair thinning, in some people; usually reversible

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:

Unusual tiredness, loss of appetite, or yellowing of the skin or eyes, especially in the first six months: worth a prompt check, as these can point to the liver, and the routine blood tests are there to catch this early
Severe stomach or back pain with vomiting: get medical care promptly
Unusual drowsiness or confusion: worth a prompt check (a treatable ammonia rise can cause this)

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 can 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 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?

This is the most important pregnancy conversation of any medicine on this site, and it 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 that reason, in anyone who could become pregnant it's avoided wherever possible, used only when nothing else works, and always paired with reliable contraception; for migraine prevention in pregnancy it isn't used 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 generally more workable than pregnancy and is decided case by case. Our guides to medication in pregnancy and medication while breastfeeding cover the details.