Bipolar Out Break 8 Months Later

[boogie2dope 25]

I post this to see if anyone else has had a Psych Med for Depression, Anxiety, or Bi-polar that has to build up in the system to be impactful, like Depakote DR, Effexor ER ,etc. If so, I'd be interested in your story and how you are managing.

Stuff Just Hit the Fan

I had my RYGB last August, 2021, and I'm down a good deal of weight and was feeling great! Then the end of February rolled around and I started getting little headaches, not sleeping all night, and having the odd panic attack after a period of years of stability. Then all hell broke out. Headaches from dawn to dusk, insomnia every night, rage, restless legs, constant stress and panic.

I thought we had prepared for this by switching my 2,000mg Depakote (Delayed Release) to 2,000mg Valproic Acid Oral Solution (Immediate Release) prior to surgery. Even one month after surgery my levels were fine (two months on the Immediate Release Liquid.) Somewhere in the past 7 months my doctor forgot to have my levels checked again, and since I was feeling good, I didn't remember either. I was able to get into my shrink mid-March and he added me to Geodon to try to stabilize me, 20mg x2/day. He isn't very knowledgeable about the Valproic Acid Oral Solution, and I had to ask him for a blood level test. Low and behold my levels came back at half what they were 7 months ago, and I'm quite certain this is why I'm having these problems.

For the past two weeks I've been adding 1,000mg of crushed Depakote DR to applesauce daily and eating it. The only risk that I can find from my research is liver toxicity, but this is something that we can monitor for, and with how bad I was, and still am sometimes, feeling, I will roll those dice. How I understand the DR coating on the pills that I had to come off of for the surgery is to help the medicine make it past the stomach into the small intestine where it gets absorbed, but since we now have a much smaller stomach (and small intestines' too?) taking them whole won't work.

[lizonaplane 1,604]

I have bipolar disorder but I don't take any DR/ER meds; I was also told those can be an issue with sleeve or bypass. If your levels are half what they should be, why wouldn't your doc prescribe it twice a day, rather than crushing a DR pill? Is there a standard release pill form of valproic acid? What about lamictal instead? I take lamictal with no issues (so far - I'm 7 months out) but everyone's different. I'm so sorry you're struggling. I hope you find a good solution.

[boogie2dope 25]

3 hours ago, lizonaplane said:

I have bipolar disorder but I don't take any DR/ER meds; I was also told those can be an issue with sleeve or bypass. If your levels are half what they should be, why wouldn't your doc prescribe it twice a day, rather than crushing a DR pill? Is there a standard release pill form of valproic acid? What about lamictal instead? I take lamictal with no issues (so far - I'm 7 months out) but everyone's different. I'm so sorry you're struggling. I hope you find a good solution.

Hey, thanks for the reply. I'm not super confident in my shrinks ability to understand the surgery and how it impacts the medication I'm on. We did switch to a liquid version of the med, which is slightly different than the Depakote pill (see Valproic Acid Oral Solution 250mg /ml VS Depakote DR 500MG Tabs), prior to the surgery at my suggestion, as he was unaware of any other form of the medicine and was hesitant to change me since I was stable at the time. My RYGB surgeon is hands off when it comes to Psych drugs, so he referred me back to the Psych who I am not 100% on. I'm currently looking for a new doctor, but until then, I will do what I think it will take to get my mental health in order b/c it's been pretty bad. I will bring up your suggestions though, as far as trying the additional whole pills instead of crushing, and the lamictal.

[redhead_che 824]

Was there not a psychologist or psychiatrist in your Bariatric consults or team? We have 2 in our program as resources for patients with mental health needs. I’d hate for that to not be common :( so sorry you are struggling! I wish I had insight but all I have is a friendly internet hug 🥰

[JessicaOKelly 0]

Hi, new here and having RnY soon (all labs, tests etc done) just waiting on next appt with surgeon to get the date. Anyway psych meds are one thing that really worry me. I’m on Wellbutrin XL and Lamictal. Primary doc who prescribes says both are time released so I’ll need to switch formulations. I don’t do well without meds and scared I won’t absorb.

[boogie2dope 25]

On 4/21/2022 at 7:25 AM, redhead_che said:

Was there not a psychologist or psychiatrist in your Bariatric consults or team? We have 2 in our program as resources for patients with mental health needs. I’d hate for that to not be common so sorry you are struggling! I wish I had insight but all I have is a friendly internet hug 🥰

Hey, thank you for the comment and internet hug! We do have psych's on the weight management team, but it's such a large number of specialist and doctors at OhioHealth, I tend to get the "please refer to your existing PCP, or prescribing physician," answer. I did reach out to the psych I met with prior to the surgery but by this time I am already onboarding with another psych. I'm hoping this new one can help some. Things have gotten a little bit better, but I'll have a few good days, then a few very bad days. Mentally I'm preserving through shear grit and determination, b/c I want to enjoy life with now that I've lost all this weight, and I know there has to be a end to this tunnel.

The new doctor wants to put me on Lithium. I will have to do some research on how it is processed after RYGB. I would be on Valproic Acid Oral Solution, Geodon, and then the newly added Lithium. Seems like a heck of a lot. I would start to worry about potential renal issues. We'll see what happens. I'll update when I know more.

[boogie2dope 25]

On 4/21/2022 at 8:17 AM, JessicaOKelly said:

Hi, new here and having RnY soon (all labs, tests etc done) just waiting on next appt with surgeon to get the date. Anyway psych meds are one thing that really worry me. I’m on Wellbutrin XL and Lamictal. Primary doc who prescribes says both are time released so I’ll need to switch formulations. I don’t do well without meds and scared I won’t absorb.

I think Wellbutrin makes a non-extended release, same as Lamictal. Have you inquired as to IR versions of these medications? Definitely do the leg work to get this done before your surgery. I thought I had done enough as I had researched and knew I had to get a different format of my medicine, but for whatever reason, I've wound well below therapeutic ranges in my blood levels for my bi-polar medication. Let us know what your Doctor says.