Q:  Can Depakote Cause Diabetes II?

I have had this bi-polar problem since age 45. I am now 58 and on medication Depakote each day.  I also have diabetes II.   Has this medication caused diabetes II over the years ? Should I change this mediction. Lithium was not acceptable to my illness because the side effects were too great to deal with. Your recommendations would be appreciated.

Thank you.

 

Dear Mr. G' -- 
There is accumulating evidence that Zyprexa (as opposed to Depakote) can cause diabetes through the metabolic shift it appears to cause, even sometimes independent of the weight gain it very commonly causes.  

So now many people, probably including you it sounds like, are looking back at our experience with Depakote over the years and wondering if it too might have a similar risk (though if found, it would probably be lower, based on the frequency and severity of weight gain at least).  You may have found my review of this subject under Metabolic Syndrome on my site, which would be the place for readers to go for references on all this.  As shown there, Depakote has been in one study shown to induce some metabolic shifts within weeks, before weight gain shows up and without appetite increase. 

However, so far I'm not aware of any more direct evidence that Depakote can lead to diabetes.  Instead it's more a matter of extrapolating from the Zyprexa experience.  Even in that case it's not been clearly shown that Zyprexa is causing diabetes, but the evidence certainly seems to be mounting as I see it.  Thus reasoning backwards, I think it's plausible that Depakote may have played some role in your diabetes.  

Reasoning forward, does this mean that we should avoid using Depakote for this reason?  I think clearly we are not there yet, whereas in the case of Zyprexa I aggressively caution patients about the weight gain risk we face if the medication is continued beyond a short-term phase of getting severe symptoms under control.  The problem is that we know we're looking at long-term medication use in most people, so we have to look for agents that can be taken in most cases for years.  And we don't have many well-known options in that respect once you go beyond lithium and Depakote.  So, reasoning forward, we're still stuck at this point, because of the lack of well-known alternatives, with Depakote as one of the primary options, even though you're right, there may indeed be some risk of inducing diabetes.  Please note the language:  "may...some".  It's all about balancing risks while trying to get the known potential benefits relative to potentially severe symptom risks.  

Dr. Phelps

Published September, 2003