Depakote vs Lithium

October 10, 2009

Lithium has been used for over half a century to treat mood disorders -- yet it's still imperfect, and its mechanism isn't entirely certain.

Lithium has been used for over half a century to treat mood disorders -- yet its mechanism isn't entirely known to neurologists.

Fierce online debates about Batman vs Wolverine contain a lot more reliable detail than those about Lithium vs Depakote.  These are the two “biggies” that psychiatrists prescribe for Bipolar, yet they’re really hard to compare,  even for professionals.

Both Depakote and Lithium…

  • Treat mania
  • Treat depression, to a lesser extent
  • Often cause weight gain
  • Are semi-mysteries
  • Are maintenance drugs
  • Require blood level tests to prevent poisoning

Their differences sort of balance out too:

  • Lithium has a stigma, but a solid 50-yr history; Depakote has no stigma, but less extensive time in use
  • Depakote is thought to be effective when Lithium isn’t (eg, for rapid-cycling); but Depakote more often needs to be taken with additional medication

…And perhaps it’s telling that I can’t think of any other certain differences that one could weigh when trying to decide between the two drugs.

Trustworthy details are scarce….  I searched on PubMed for recent studies that mention both Lithium and Depakote — please follow the links to the briefs and draw your own conclusions!

  • Nov 2008, NIMH, Bethesda — Trouble with affective processing and attention is linked with medication (Lithium & Depakote) rather than the disorder itself; yet the attention problem is exacerbated in medicated people diagnosed with type II rather than type I
  • Sep 2008, University of Texas, San Antonio — A finding that Depakote compares well to Lithium in acute mania remission rates
  • Jan 2008, McMaster University — Lithium can affect the hippocampus by increasing its volume, which sounds scary; if I understood the brief correctly, Depakote doesn’t do this. (I also found a cryptic brief that may imply that this very thing is a benefit of Lithium!)
  • Nov 2007, UCLA — An inconclusive study that shows similar effectiveness of Lithium, Depakote, and Carbemazapine (Carbatrol, Epitol, Equetro, Tegretol) on sucidal behavior
  • Jun 2007, Ankara University — Verbal memory impairment found in people with Bipolar is the same whether they’re being treated with Lithium or Depakote; either the impairment is a symptom of the disorder, or an equal side effect of both drugs
  • Jun 2006, Harvard — Depakote may cause a small but significant percentage of women to exhibit symptoms of hyperandrogenism (stuff like hair loss and cessation of periods – basically, becoming a bit more man-like)
  • Nov 2005, Case Western Reserve — Depakote is not necessarily more effective than Lithium for rapid cycling
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2 Responses to “Depakote vs Lithium”

  1. dvora24 said

    This is very interesting. I hadn’t even heard of Depakote before. Practically everyone has heard of Lithium.

  2. janusjana said

    Yeah, I’d never heard of it before, either — it’s been around over a decade, though!

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