Is it possible that a 110 lb adult woman can only require Depakote-ER 500mg/day when euthymic and 1000mg/day when slighlty hypomanic? She gets drowsy and sleeps more than 7-8 hours when taking 1000mg and too much sleep seems to promote depression. Is it necessary to use at least 1000mg or is 500mg enough to stabilize mood in Bipolar I? Is there an inbetween dose?


Dear Mike --
As your surmise, all these things are indeed possible, and there is -- therefore -- an intermediate dose approach.  Depakote also comes as a 125mg "sprinkles" capsule (there's a 125mg pill too but that's not the ultra-slow-release pattern like the Depakote ER, whereas the "sprinkle" capsule is).  Theoretically 4 of those would be roughly equivalent, though probably slightly higher as they are potentially better absorbed, to one 500mg ER; so you can work down to an intermediate dose by 125mg steps (e.g. one 500mg ER plus as many sprinkles as it takes, up to 3 anyway, to stop cycling but hopefully without sedation.   Good question; encourage her to discuss this with her doctor. 

Dr. Phelps