Dr_Anderson : Greetings, and thank you for the question. Based upon the prior conversation we had, I'd opt to cut back on the Epilem. Several reasons for this: (1) In my patients who take valproic acid (VPA), or Epilem, a number of them have become depressed if their VPA dose was too high. So, it is necessary to check the blood level and make sure that is not the case. If the dose is too high, cutting back makes perfect sense. (2) VPA tends to be sedating, it tends to have a tranquilizing effect, so that can of course present as or be confused with a lowering of the mood. (3) Zyprexa works faster and can act as a mood stabilizer in its own right. Thus, if the mood behgins to switch up into a mixed or maniuc/hypomanic picture, a change in the Zyprexa can take effect faster than can a change in the VPAS, under most conditions.
Dr_Anderson : Of course, it is necessarey to make sure the mood is cycling and staying down; if this down is only a few days or weeks old, it might just be a down phase before another up-swing or mixed state. In such a case, having the same dose of VPA and not changing it (or the Zyprexa) would be best.
Dr_Anderson : Lots of info given here! Hope this helps. Please let me know how else I may be of service!
Dr_Anderson : Regards, XXXXX XXXXX