Q:  Questions re: Depakote

Hi Dr. Phelps,
I wanted to know if there is any research on Depakote working on people who display no depressive symptoms or who are just depressed due to psychological reasons with no chemical imbalance? 

Sounds like a dumb question I know.  My therapist thinks I may not need any meds if I work on some psychological unresolved issues, which I am working on currently. 

Here is my background:
I was diagnosed as bipolar when I was 17, I resemble the symtoms of bipolar 2, I am 37 now. I have not taken any meds except for a brief period 9 years ago and have led a productive, useful life during that period.   I have been sober (A.A.) for 10 years.  I have had an underlying depression all along coupled with social anxiety.  Both have been muted and managable for the past 10 years thanks to A.A. although I may just have a high tolerance for discomfort. During the last 6 months the depression and social anxiety became unmanagable.  I raised the white flag and saw a psychiatrist.  He gave me Depakote.  The depression vanished in less than 24 hours!  To a lesser degree so did the social anxiety.  It was amazing, it worked like aspirin on a headache!

So my questions are:
1) If the cure works, does that mean I have the symptoms?
 
2) Would depakote work on somebody who doesn't have some sort of chemical imbalance, someone who is just depressed due to only psychological issues?

3) Would Depakote have any effect on someone with no depressive symptoms at all?

4) Is there any research on this?

Thanks for your time Dr. Phelps,

Dear Mr. M' -- 
Thanks for your polite and careful way of asking the questions.  Taking them in turn: 

1) If the cure works, does that mean I have the symptoms?
 Interesting way of phrasing it. Seems pretty clear that you had the symptoms.  At least depression and social anxiety, as you explained. Then we might have to figure there was some sort of hypomanic symptom(s) of some sort back at age 17 to get that label (assuming accuracy there, not a given). 

If all that is correct, then you have had a rather unusual experience with "bipolar disorder".  No mania or hypomania or cycling since one episode at 17? Or was it just that the more obvious symptoms during that time were the depression and social anxiety?  That would be much more common (perhaps you were just trying to keep your letter brief).  

Either way, it seems tricky to assume that you do really have bipolar disorder. I wouldn't start with that assumption based on the information here. Therefore how to interpret this "cure" is similarly ambiguous.  Much depends on what happened at 17. If that was very clear hypomania or mania, and there is little doubt about some "bipolarity" in the picture, then I would interpret the Depakote effect as basically a variation of what we see frequently when using Depakote in more classic bipolar I or bipolar II. 

2) Would depakote work on somebody who doesn't have some sort of chemical imbalance,
someone who is just depressed due to only psychological issues?
To my knowledge that has not been studied -- assuming I know what you're asking. However, the question could be adjusted a bit.  For example, take "Generalized Anxiety Disorder".  This could be considered a "psychological issue", in that people are worrying about all sorts of things they can recognize don't merit that much worrying.  This can be treated well with a GAD-specific cognitive-behavioral psychotherapy.  If that was what you mean by "psychological issue", then the fact that Depakote has been shown to be of benefit in GAD might partially address your question. 

But GAD also responds well to several different antidepressants, possibly most of them (has only been officially studied with some, not all).  So maybe that means it's not entirely a "psychological issue"? Perhaps what you mean with that phrase is something more like what we therapy-types would call "psychodynamic issues", a phrase which harkens back to or at least toward old Sigmund Freud and those who followed in his wake. Several of the fundamental structures in that kind of thinking really are useful (and several are clearly not, we can now see, such as the death wish thing he got into). This includes a recognition that relationships with our parents have great power and can be re-experienced in part, sometimes significantly, in relationships with other people as we get older (now generally regarded as "attachment issues" and studied as such). Depression due to attachment issues (such as loss of an important adult relationship that had some attachment-power in it) might be an example close to your question about "depressed due to only psychological issues". 

Thus we could ask if Depakote might do anything to these "psychological issues". To my knowledge there is no literature on this (it would odd if there were, as there is little basis for thinking Depakote might help in this realm). 

3) Would Depakote have any effect on someone with no depressive symptoms at all?
Not sure what you mean here as you haven't been having hypomanic symptoms either, so it would be unclear why a person with no hypomania or depression would end up taking Depakote. But suppose someone with no symptoms at all took Depakote.  In most cases when I've discovered later that I was barking up the wrong tree with Depakote, or when for some reason it seemed later to be unlikely to have been of benefit, in those people, often nothing at all happens. I just saw a fellow yesterday who's taking 1500 mg and can't feel a thing. 

Hope that addresses some of what you were after.

Dr. Phelps

 

Published August, 2005