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Dr_Anderson, Doctor
Category: Mental Health
Satisfied Customers: 335
Experience:  Psychiatrist
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For a lowering mood would you cut back on Zyprexa or epilem

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For a lowering mood would you cut back on Zyprexa or epilem and why?

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
Customer: replied 5 years ago.
How soon after cutting from 800 mg of epilem to 500 mg will it take to feel any different, and will I have withdrawals ?
Since I'm not sure of the dosing availability in your area, am I correct in presuming you are taking a 500 mg and 2 150 mg pills? It would probably be best, XXXXX XXXXX is the case, to go down from 800 mg to 650 mg, wait a few days to a week, then go down to 500 mg. This way, if you mood worsens (mixed or manic) over that period of time, you can quickly go back up to the higher dose.

There should not be any withdrawal side effects, but just in case, tapering down as noted above should prevent such a problem.

Now, presuming you have gotten down to 500 mg, with no mixed or manic symptoms, then you should be able to see a difference in a couple weeks, if indeed the low mood was due to the VPA. This is because even though the medication itself is out of your system quickly, the effects it has had in your brain take a little longer to wear off.
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