Trouble reaching theraputic level?


Has anyone's difficult child had trouble reaching theraputic level on Depakote or any other mood stabilizer? Our difficult child had tried Lithium, which did not work. He had been on Depakote 125mg 2x daily. His blood level was 60. The psychiatrist wants him at 100. We increased over a few days to 250mg 2x daily and his latest test shows a blood level of 50. psychiatrist is a little stumped. Fast metabolism?

I just had a blood panel done through pediatrician's office and thyroid was fine.

Any suggestions?


Well-Known Member
I don't know the answer to this, but I'd guess metabolism may be the key here. I'm going to post a link over in General so that this topic we'll get a wider audience and possibly more responses.


Active Member
I don't know enough about the metabolic pathways for Depakote. One thing, however - with some medications at least, there can be a delay between adjusting the dose, and getting the blood levels you want. You can end up in a see-saw oscillating arrangement.

It would be interesting to know what other factors there are, in Depakote metabolism. How does the body use it/take it up? Is it stored anywhere in the body, or does excess get excreted? if excreted, by what means? What dies it interact with? Can it be bound up with anything it could be interacting with?

If psychiatrist is stumped, what about talking to another doctor in a different specialty? A GP is by definition a generalist, they are often better trained to see the bigger picture. Also, talking to the pharmacist who is providing the medication can help to find some clues. These people should have the training as well as access to the information, to help determine the answers.



Active Member
Just a note from personal experience......labs can be wrong. We have had 2 lab results prove false. Our psychiatrist has learned over time, if something doesn't make sense in a blood work result, to re-test before we move on. Just a thought.


New Member
Yeah, we've had bad labs too. One time we took Dylan's Lithium level and it was .38 LOL! He was on 900 mg., umm, no way in heck! So, we retested, came back at .79 three days later. Much better.

Also, I'm pretty sure you have to fast for Depakote as well? Dylan has to fast for Lithium levels.

I'd be concerned in itself that the psychiatrist is stumped LOL! I mean, being a psychiatrist, he/she should be able to have some type of answer, or call the lab to see what's going on, or find out on his/her own what the issue is.
What time does difficult child take Depakote and then, what time does he get the blood draw? With our difficult child, she takes her Depakote only at bedtime and we get blood draws approx. 12-14 hours later. This is when our psychiatrist says the Depakote is at the "trough level" and the best time to get a good read on the level.

I don't remember what difficult child's level is but I know she is in the high/normal range.

Good luck!! Hugs,


Well-Known Member
Never had to go with any medication that required a blood draw - thank goodness because difficult child freaks at needles!

I would have it re-tested, too.


Thank you all for your advice. We have never been told to fast for either lithium or depakote levels. We are waiting the 12-14 hour period before testing. I will check on the fasting part.

Wiped Out

Well-Known Member
Staff member
jal-JSK was right on about the time thing I forgot about that. In fact I remember the psychiatrist was very specific-he said it had to be 12 hours and no more no less. We would give about 15 minutes either way but sometimes had to be bumped up ahead of others waiting for their blood draws.