medication wash finished -- starting Depakote today


Here we go again!
psychiatrist squeezed us in today and he got to see difficult child 2 after a week-long medication wash... first time he's seen him like this in about 5.5 years. Right now the biggest issue is the impulse control and the mood problems. psychiatrist feels that there is a mood/BiPolar (BP) element possibly evolving, and in five years or so he could very well be in a full-blown state. But right now, it's sort of at a subclinical level, but something, whatever it is, is there besides the ADHD, because of how he's responded to the stimulants so far (needing higher and higher doses as it becomes ineffective over time).

Anyway, we're starting Depakote today, 250mg for 5 days, then increasing to 500mg for 5 more days, then I'm to call with an update (and obviously would call if things deteriorate before then). His hope is that it will address the mood and impulsivity problems. If it works, then we'll look at re-introducing a stimulant for the ADHD/focus component, but at a much, much lower dose than what was needed before. I'm not even going to think about it not working. :eek:

I also told him about the second opinion I'm seeking, and he was all for that. I guess we'll just move forward with the Depakote as planned, instead of trying to get him into the other psychiatrist office medication-free. I'm sure if this other guy's any good, he'll be able to make a valid assessment based on what he sees and the history he's given. He can also call our other psychiatrist if he has any questions.

I so hope that this is finally the right direction for difficult child 2. It feels like it's been such a long, drawn out journey that has only created more confusion as time has gone by. I'm not eager for any particular labels to be applied to him, just eager for a solution to his behavior problems!

Thanks for sharing your experiences and for listening :smile:


Active Member
Wow. Good luck. The medication maze is amazing, and very frustrating. My difficult child is at a fairly good place medication wise, and I hope it lasts a while.


Depakote was the first medication given to my difficult child 1 after he had his prolonged intense manic reaction to Zoloft. It stopped his raging in its tracks after 6 weeks at a therapeutic dose. I hope it works for your difficult child 2, too. You may begin to see improvement within 2 to 3 weeks of attaining a therapeutic level, but maximim clinical response genreally occurs 6 to 8 weeks after the therapeutic dose is reached.

Depakote levels are measured by blood draw after 6 days at a steady dose. Some kids respond best at levels of 80 to 90, but others require levels of 100 to 125. I hope your psychiatrist is ordering blood work along the way not only to check for therapeutic levels, but also to rule out the rare side effect of liver toxicity.


Here we go again!
Thank you -- Yes, before we left, psychiatrist gave us orders to check valproate levels and also a metabolic profile two weeks from now. By that time, difficult child 2 will have been at the 500mg level for five days. psychiatrist did say that we'll have to have labs drawn periodically as long as he's on this medication.

We're already at the lab every few months for difficult child 1's labs because of his Crohn's disease medications, so what's one more? :rolleyes:

I'll just be happy if we can get a good handle on this before school starts!