Alternative to Meds Center understands that Depakote tapering (valproic acid) is best done carefully and gradually to avoid some of the more extreme withdrawal phenomena that are possible.
Mood stabilizers that are given during a crisis often devolve into a lifetime of being medicated and all of the side effects that go with it. In over 81% of the cases, we have found that people can navigate their lives better long-term after having withdrawn from the drugs.
Do Your Symptoms
For 15 years, Alternative to Meds has been the only licensed antipsychotic tapering center helping people find holistic alternatives to mood stabilizers and other medications. We have published evidence regarding our long-term success. While each case is different, we find that frequently there were medical conditions like hypoglycemia or food allergies, or that the crisis had multiple factors that contributed and were overlooked. For these reasons a person may have been diagnosed either prematurely or entirely misdiagnosed and a more in-depth inquiry would be warranted.
15 Years Experience by Professionals Who Understand Your Journey.
Depakote tapering — a gradual, carefully managed reduction — is the safest way to stop taking this mood stabilizer, classed as an antiepileptic medication. Abruptly stopping Depakote is NOT recommended as it can result in seizures that do not stop and other serious withdrawal symptoms.2 More details on withdrawals can be found in the section called “Depakote Withdrawal Symptoms,” below.
Depakote is linked to major congenital deformities such as spina bifida, deformed heart, limbs, and lowered IQ in the child. These malformations are shown to occur during the formation of the embryo, which means the first 8 weeks of pregnancy. A properly informed woman may decide that Depakote tapering is a very wise health choice well before any chance of becoming pregnant.5,34
Continuing a prescription of Depakote may become impractical due to side effects including sedation, confusion, loss of coordination, and vision problems if their job involves driving a vehicle, flying a plane, or operating heavy machinery.1,3 Find more details in the section below called “Depakote Side Effects.”
Overall, a person can assess the risk-benefit ratio of staying on a drug or not, and we also recommend researching Depakote alternative therapies that may offer other forms of help for mood swings or migraines or whatever the original symptoms were. The Alternative to Meds Center offers such an opportunity. The center offers an inpatient Depakote tapering program, using neurotoxin removal, orthomolecular and nutrition-based medicine, lab testing and diagnosing root causes for unwanted conditions, and a wealth of additional therapeutic activities that can be tailored to the individual’s needs. We hope the following information helps in your research.
Depakote Tapering Guidelines and Schedule
The conversation about Depakote tapering is from the perspective of it being a mood stabilizer. We are not suggesting that the same methods be administered to a person with a seizure disorder.
For persons with a seizure disorder, we cannot give viable guidance as your situation will need to be designed directly with your prescriber. And regardless of the reasons why Depakote was prescribed, the below is only given so as to share with your prescriber, and most definitely not to act on without support.
If an inpatient setting is not available, find a prescriber to work with who is familiar with tapering protocols for Depakote, and who is supportive of your desire to taper. An unsupported taper is likely to go off the rails.
Depakote Tapering Guidelines Include:
Begin Depakote tapering only when in a stable condition. (See below for more information.)
Set up a “contract for safety” with a trusted family member or associate before you begin the process.20 (How to set up such an agreement is described in more detail below.)
Seek inpatient care or at the very least, find a prescriber who is familiar with tapering protocols and willing to help you. Close medical monitoring is highly correlated to a successful outcome.28,33
Discuss other medications you may be taking with your prescriber so your tapering plan can accommodate the best sequence in multiple drug discontinuations in a safe way. Inform your prescriber of all drugs taken concurrently including aspirin, antidepressants, antibiotics, oral contraceptives, and any others due to potential drug interactions.3,19,27
You can ask your prescriber for the lowest dose version of your Depakote to more easily configure reduced doses as your tapering progresses. (The lowest dose tablet is the pink oval 125 mg tablets.) For extended-release or sprinkle capsules versions, your prescriber can assist with methods of dose reductions for accuracy.
The last cuts may be the most difficult. Work closely with your physician and go slowly.28,33
Discuss with your prescriber the option (if needful) to get a bridge medication such as Gabapentin prescribed at points of particular difficulty during the taper.14
Regular exercise is recommended for positive benefits on mental health.16
Caffeine from any source should be avoided due to its stimulant properties, and potential effects on interfering with drug metabolism.15
Avoid marijuana or other recreational drug use18 and eliminate alcohol. Alcohol can have harmful interactions with Depakote and disrupt the taper process.19
Diet can help keep blood sugar balanced. A protein-based breakfast and numerous small protein-based meals over the day are better than 1 or 2 heavy, high-carb meals that may cause blood sugar levels to spike and crash.13
The percent of reduction and the duration between cuts will depend on factors such as the intensity of symptoms, and how long it takes for each level to settle out. How long a person took drugs such as Depakote can influence how long to expect the withdrawal to take.17
Become acquainted with symptoms that could manifest during the withdrawal33 and speak to your prescriber about any new symptoms so you are working together as a team. More information on Depakote withdrawals is given in the earlier section called “Depakote Withdrawal Symptoms.”
For your own safety, let your prescriber know if you notice red flags such as not sleeping, not eating well, or compulsive or other behavioral changes in your routine. These may indicate that tapering may need to be slowed (or dosage temporarily raised).28,33
Consider limiting reading material, internet usage, and media of all kinds that you find overstimulating. Quiet, calm activities may be more helpful, ie., a pleasant walk, work that you find easy to do, hobbies that you find engaging and relaxing, yoga, mindfulness awareness training, forest bathing, and other enjoyable activities in a calming environment.28,29,30,31
There are, rarely, instances when rapid or abrupt discontinuation of a drug like Depakote is medically necessary to save the life of the patient. For example, anticonvulsant-induced movement disorders, and other potentially life-threatening reactions such as Stevens-Johnson syndrome are rare but are known adverse events associated with Depakote. These must be treated in a hospital setting such as an emergency ward or ICU where abrupt discontinuation is most safely achieved.4,28 Alternative to Meds cannot provide the emergency medical treatment that is needed for rapid withdrawal in such cases, and we are not in a position to give guidance regarding rapid Depakote withdrawal.
Begin Depakote tapering only when you are in a stable condition.
It is best to begin a Depakote taper when the person is reasonably tolerating the medication, sleeping well, eating regularly, doing regular exercise, is under competent medical oversight from a willing prescriber. The best candidate would have eliminated caffeine and other stimulants, alcohol use, marijuana, or other recreational drug use because these substances can interact with and interfere with the medication’s mechanisms of action. This can throw a wrench into any taper program. having a support circle is extremely beneficial for support from family, close friends, and sympathetic mentors. Also arranging one’s life in an organized fashion might include engaging in hobbies or light work to focus on. If you are not sleeping well, that should be taken care of with the help of your prescriber or using holistic means that work well for you beforehand.
Contracting for safety — what it means.
A person in a manic state may become unwilling or unable to follow directions. However, following directions is vital for a successful taper. It is recommended to discuss and voluntarily draw up a written contract that can be presented when needed. Putting this solid commitment in writing to agree to follow the doctor’s tapering directions can get things back on track. For example, if the person has stopped their meds and has become manic or psychotic, they may become unwilling to continue the taper as agreed. This is a safety risk for the person that the contract for safety was put in place to remedy. Part of the agreement would be to acknowledge that non-compliance will result in police involvement, or having to go to the hospital. For the person’s own safety and those around them, the contract for safety is a vital safety net for anyone tapering from ACD’s and other unpredictable neuroleptic drugs.20
Set up medical support before your Depakote taper.
There are holistic psychiatrists and other prescribers who can assist you with an outpatient style taper. Certainly, we recommend inpatient care when possible, but we know it may not always be possible or practical for everyone. When you find your outpatient doctor, you are welcome to share our information with them if you like, and we hope it helps open the discussion.
Eliminate all forms of caffeine or other stimulants, recreational drugs.
This is so important it probably should be #1 on the list of guidelines. Use of stimulants, even too much coffee, tea, or soft drinks, alcohol or recreational drug use, can all potentially land you in the hospital. This is because of the mechanics of how stimulants and alcohol impact Depakote, resulting in a flood of excitatory neurochemicals. Restrict these items and stay safe.15,18,19
Food choices to control blood sugar spikes.
Blood sugar spikes and crashes can disrupt tapering with a vengeance. Choose low-glycemic, protein-based foods and snacks to prevent unnecessary problems. Don’t let hunger disrupt your progress. Breakfast should be protein-based giving a good start to the day. Follow up with smaller protein-based meals that also incorporate your favorite vegetables throughout the day. Experiment with some rutabaga or cauliflower for “mashed potatoes” — delicious with butter! Avoid refined flours and sugars or find low-carb replacements. Snacks like non-starchy veggies, peanut butter, avocado, raspberries, blueberries, dill pickles, cheeses, delicious cold cuts, and other sugar-free foods can deliciously fill in the gaps as needed.13
Many Benefits of Exercise.
Exercise has been documented well for the benefits to physical and mental health. For example, Sharma et al’s comprehensive summary24 of benefits for mental health lists improved mood, energy, and better sleep as some that should be emphasized and reinforced by all mental health professionals. In addition to these benefits, Albrecht Messerschmidt’s 2010 book, Comprehensive Natural Products II, discusses the role of oxygen in certain chemical reactions, such as modulating dopamine molecules.25
This would be a very good reason to blend some aerobic, cardio exercise into the daily routine where a person with excess dopamine may benefit from this regulatory function. According to Science Daily, regulating the “happy hormone” dopamine is important. Too little dopamine is linked to Parkinson’s disease, and too much dopamine is linked to mania, hallucination, or other psychiatric symptoms. Exercise is an extremely good tool that can help regulate this important hormone.26
Use the smallest milligram dose of Depakote available to use for the taper.
The smallest milligram dose of Depakote is the dark pink oval 125 mg tablet. This does not mean you want to drop to the lowest dose. Smaller pills will help configure the medication total accurately. For example, if you are on 1500 mg Depakote, you will want to have the 125 mg version available so that if you were to drop down to 1375 mg, you could take two of the 500 mg (for 1000 mg), cut one of the 500 mg in half (for 250 mg), and then add one of the 125 mg to equal a total of 1375 mg. It also might be that you get the 250 mg and the 125 mg versions prescribed to make the math easier. You can cut the Depakote 125 mg in half giving you 62.5 mg. These small cuts are not necessary for everyone, but for some, slowing it way down is the only path to re-regulation after the use of the drug. You can cut any of the Depakote versions in half to configure the correct milligram dosing needed. However, if you are on Depakote ER when you cut the pill, it will lose the extended-release attribute. They do make a 250 mg Depakote ER version. So if you are on the ER version, many people can configure the tapering dosing amount in 250 mg increments. If you are planning to make smaller than 250 mg cuts, the regular non-time-released version would be likely easier for that purpose. So let’s say a person is trying to get to 875 mg. They might take three 250 mg Depakote ER, and 125 mg Depakote (non-time-release), for a total of 875 mg. These configurations can be worked out with your prescribing physician for accuracy of dosage. Keep a written record — don’t rely on “mental math” in the middle of a Depakote taper.
Other medications you are on.
The CDC reported that between 2015 and 2018 about 24% of the US population took 3 or more medications over a 30 day period, and over 12% took 5 or more medications in the same period. It is not at all unlikely that a person who has been taking Depakote for some time may have also been prescribed other medications for various reasons. Tapering within an inpatient setting would be particularly advised in this case. The order or sequence of which medications to taper is vital so as not to overwhelm the body by introducing too much change all at once. These matters can be assessed and managed more easily in an inpatient setting, as both the micro-changes and the broader modifications can be made when needed on an immediate basis.21 In any case it would be advised to speak with your prescribing doctor who is helping with your taper and discuss the best sequence, depending on what medications were prescribed and for what reasons they were originally prescribed.
Factors that would have to be considered include how long a person was taking each drug, the symptoms the person was attempting to control, current symptoms, and other issues that are unique to each individual.
How long will Depakote tapering last?
Because each person has unique biomarkers, genetic profile, medical history, sensitivities, individualized sets of symptoms, and so on, there is no “one-size-fits-all” when it comes to Depakote tapering. Like maneuvering down a mountain road, sometimes shifting to a lower gear is more effective than slamming on the brakes too aggressively. Slow and safe are the keywords to keep in mind.
Some medications may take months, or even years to resolve as demonstrated in benzodiazepine clinical studies,22 as well as studies on discontinuation of mood stabilizers.23
However, we have observed that when effective tapering support is provided, these numbers typically decrease as the body is maximally assisted in the rehabilitation of its normal neurochemistry.
Red Flags of Depakote Tapering
Returning to our analogy of driving a logging truck down a mountain with switchbacks on an icy road, you have to go light on the accelerator — go slow — and be ready to use your brakes. If you are a patient, skillful driver, you will get safely down the mountain. Free-wheeling it will likely end in a crash — an avoidable disaster. Accelerating around the turns because it feels good can turn out like the wreck that you would anticipate in our driving scenario. We observe similar laws of gravity and inertia involved in Depakote tapering. Go slow so you can get down the mountain. That is the over-arching axiom.
Not eating, not sleeping, intense side effects, and perseverating (obsessing) over a certain topic that will not leave your mind are all red flags. These are signs you are heading into the danger zone. For instance, after the second day of not sleeping, that could be a signal to pay attention to. It may be that you need to go back up on your medications. Then you can work your way back to the earlier dose. Please talk to your prescriber about the likelihood of encountering these moments of crisis before you begin Depakote tapering so you have a better understanding of what to expect. Don’t try to figure it out mid-crisis. You don’t want to end up in the hospital back at square one. If you begin to feel you pose a danger to yourself or those around you, just play it safe and get checked in the hospital. Hospitalization is not a failure. It could be that being medication-free is not the best outcome. Or it could signal that a much longer withdrawal period is needed. Watch for red flags and respond to them by collaborating with your prescriber without delay.
Bridge medications for Depakote tapering.
Some persons may do well using what are referred to as bridge medications to ease Depakote withdrawal. At Alternative to Meds Center, various methods of tapering can safely ease withdrawal issues and bridge medications can be designed on an individual basis.
Limiting stimulating media during Depakote Tapering.
Wrestling with life questions, religious matters, watching over-stimulating movies or TV, can all be overwhelming for someone attempting Depakote tapering. Better activities might be outside walking, physical activity, hobbies you enjoy, light reading, light work, things that can pleasantly extrovert the attention, can all be grounding elements that support this tapering process very well.
Depakote Alternatives and Depakote Withdrawal Links
We have pages on our site that address Depakote alternatives that can be used during the tapering process. We strongly recommend you review these pages. Quick links are Antipsychotic Alternatives for general information on nutrition, etc., and Depakote Alternatives. You may also want to consider reading the Depakote Withdrawal page.
Depakote Side Effects
The FDA drug label3 lists the following:
Life-threatening pancreatitis (all ages)
Coma, severe or fatal encephalopathy (loss of brain function)3,8
Liver failure (fatal hepatotoxicity)
Suicidal thoughts and behavior as early as the 1st week of taking Depakote
Mood swings, uncontrolled laughing or crying, often at inappropriate times
Anorexia, weight gain, weight loss
Bronchitis, fever, flu syndrome
Bleeding under the skin causing purple patches
Blurred vision, double vision
Abnormal muscle weakness
Notes on Rebound Symptoms after Stopping Depakote Too Quickly.
For a person with epilepsy to abruptly stop or even reduce Depakote, one of the most concerning reactions is episodes of seizures that do not stop, also called status epilepticus.6 For bipolar persons, a sudden cessation of Depakote can bring on a return of the person’s original symptoms such as mania, insomnia, etc. A person who was taking Depakote as a treatment for migraines may have a return of migraines, which may be considerably more severe than before taking valproate. A person taking Depakote as a mood stabilizer, for bipolar, for headaches, or other conditions may find that reducing the drug too quickly can cause intense reactions. Sometimes these withdrawal adverse effects can linger on if they are not addressed in a healthy way as part of the tapering process.7
Depakote Withdrawal Symptoms
Depakote withdrawals can include both rebound (returning) symptoms and new symptoms, including the following:
Seizures in non-epileptic persons 9
Anxiety, agitation, irritability
Muscle aches, weakness
Loss of coordination, loss of concentration, feeling faint
Photophobia (hyper-sensitive to light)
Tachycardia (racing heart rate at rest)
Slowly reducing the medication with other support mechanisms in place are the means used to offset these reactions.
WARNING: Never abruptly or quickly stop taking Depakote. Find help to assist you with the challenges of Depakote tapering or coming off any psychoactive substance.
What is Depakote?
Depokate is an ACD or anticonvulsant drug, often used as a mood stabilizer in bipolar conditions, and used to control epileptic seizures and migraine headaches. The generic name is divalproex sodium or simply valproate or valproic acid. There is an extended-release version of the drug called Depakote ER (sustained-release), which is taken once a day and releases slowly over a 24-hour period. There is also a delayed-release version called Depakote EC (enteric-coated) which is NOT time-release but has a protective enteric coating that dissolves only after it reaches the intestines, then releasing the medication all at once. The EC or delayed-release (non-sustained release) version must be taken several times a day. There is also a “sprinkles” version which is delayed-release (not 24-hr sustained-release) that was designed to be sprinkled on soft food for those who have trouble swallowing capsules.6
While this anticonvulsant drug is not a benzodiazepine, in their 2021 book entitled “Valproic Acid.” Rahman and Nguyen conclude that the mechanism of action is in some ways similar, and involves the control of GABA distribution (and other neurochemicals) along the CNS.10 GABA is a calming natural chemical, though the complex mechanism of action and its interactions with other transmitters and molecules and messaging systems is not entirely understood. Its calming properties make it useful in acute situations such as alcohol withdrawal, where controlling symptoms of alcohol withdrawal is desired without the use of benzodiazepines.11
Contact Alternative to Meds Center
You or your loved one may be struggling to improve your situation where side effects, tolerance, or other issues are blocking your ability to enjoy natural mental health and be truly well. You owe it to yourself to find out more about how the Alternative to Meds Depakote tapering program works, whether you feel you would be a good candidate, and how it could possibly assist you to overcome these challenges.
10. Rahman M, Nguyen H. Valproic Acid. [Updated 2021 Jan 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559112/ [cited 2021 Mar 31]
32. Rahman M, Nguyen H. Valproic Acid. [Updated 2021 Oct 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559112/ [cited 2022 Jan 12]
33. Chouinard G, Samaha AN, Chouinard VA, Peretti CS, Kanahara N, Takase M, Iyo M. Antipsychotic-Induced Dopamine Supersensitivity Psychosis: Pharmacology, Criteria, and Therapy. Psychother Psychosom. 2017;86(4):189-219. doi: 10.1159/000477313. Epub 2017 Jun 24. PMID: 28647739. [cited 2022 Jan 12]
This content has been reviewed and approved by a licensed physician.
Dr. Samuel Lee
Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente. He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.
Diane is an avid supporter and researcher of natural mental health strategies. Diane received her medical writing and science communication certification through Stanford University and has published over 3 million words on the topics of holistic health, addiction, recovery, and alternative medicine. She has proudly worked with the Alternative to Meds Center since its inception and is grateful for the opportunity to help the founding members develop this world-class center that has helped so many thousands regain natural mental health.
Medical Disclaimer: Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.