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What causes headaches and weakness post Depakote and Paliperidone withdrawal?

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Posted on Tue, 26 May 2015
Question: HI..This question is directed to a XXXXXXX Psychiatrist.I am 42 and have been on
psychiatric medicines for long.For almost 5 years now i have been taking Depakote 250
,Paliris 1.5 mg and buspin 5 mg.Initially i was on slightly higher dose but this
reduced dose i have been taking since almost 2 years.I had depression but I really
didn't have anythin serious as such but to mention a few years back i use excercise
very vigorously and have a light diet coz of that i felt some kind of imbalance i
guess.Now i am more stable ,do only light walks and eat and sleep well.I am also
happily married and well settled now.I am actually trying to stop these medicines and
i was in consultation with my XXXXXXX doctor but now have moved from there.Docs here
have told me to taper it down slowly but whenever i try to stop them completlely,which
i tried several times,i get severe withdrawal symtoms...bad headache and weakness.I
guess since i have been taking these for so long i am not able to stop.
Please suggest how do i stop these medicines as i feel very lethargic also coz of
them.Is there any alternative medicine which can be taken to prevent me from getting
withdrawal symptoms and stop the above medicines.Please help!
doctor
Answered by Dr. Seikhoo Bishnoi (52 minutes later)
Brief Answer:
Gradual dose reduction would prevent any significant withdrawal symptoms.

Detailed Answer:
Hello thanks for choosing HCM for your health related queries

I can understand your concern. You are a 42 years old healthy female with no current severe psychological stressor. You are on Depakote 250 (Divalproate), Paliperidone 1.5 and Buspirone 5 mg since about 2 years. You are currently stable and settled now, but when ever you try to stop medicines you get bad headaches and weakness as withdrawal symptoms.

First of all I would like to tell you that the doses of medicines you are taking are very low doses and withdrawal from these doses would not be very severe. You have already reduced the doses and with proper tapering you can stop using these medicines easily. The symptoms of withdrawal you are having are probably due to psychological dependence and not due to physical dependence. So you have to accept this thing before tapering the doses that you might have some withdrawals but these withdrawals will not progress to severity, and are due to psychological dependence most likely.

You are taking three medicines so first goal to stop these medicines should be to stop at least one drug out of these three. In my opinion you should start with Depakote. Continue to take the doses of other drugs as per your regular dosing and reduce the dose of Depakote to 125 mg for at least 4 weeks. After 4 weeks stop taking Depakote. Then wait for at least 2-4 more weeks and then reduce the dose of Paliris by taking the tablet on every alternate days for at least 4 weeks and then stop the drug completely. Lastly reduce the dose of Buspirone in same manner. If during course of tapering the doses you suffer worsening of any symptoms then medicines like low dose benzodiazepines can help. Low doses of Etizolam or Oxazepam can help you to beat the withdrawal symptoms. Take these drugs on SOS basis. Consult your doctor for prescription of these drugs.

Tapering of doses in this manner will be easier and you can come out of dependence. Try to understand the fact that the doses you are taking are very low and tapering the doses would not cause any serious harm to you.

During course of tapering of doses take healthy food rich in proteins and complex carbs and low in fats. Concomitant use of Omega-3-Fatty Acids will also lessen the symptoms.

Thanks, I hope this helps you. Please don't hesitate to ask again for more doubts or if you want to clarify something from my answer.

Take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Seikhoo Bishnoi (43 hours later)
Thanks for your reply.I also want to mention that i have been getting abdominal pain for sometime now on the right side.I had done a scan and there are no gallstones or anything.I read somewhere it could be due to depakote.I have already started taking depakote 125mg(reduced the dose)on your advice from today.
Please suggest what can be done to stop the pain..Thanks!
doctor
Answered by Dr. Seikhoo Bishnoi (2 hours later)
Brief Answer:
Depakote at high dose may cause liver toxicity in some individuals

Detailed Answer:
Hello again and thanks for asking a follow up

It is not usual to get abdominal pain with doses of Depakote you are taking. You were taking 250 mg and now reduced to 125 mg and these are very low doses to cause any significant side effect. Epigastric distress can be seen with the drug but localised right sided abdominal pain is seen usually at high doses. Still if you want to be on safe side get your liver function tests done. Slight elevation in liver enzymes is commonly seen with Depakote and in some rare individuals it can cause hepatotoxicity. Take plenty of water and if pain worsen visit your doctor. OTC antacids can help you in reducing the pain.

Thanks, I hope this helps. Please ask again if you have more doubts.
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Seikhoo Bishnoi (52 minutes later)
I did my abdominal scan recently and was diagnosed with grade I fatty liver.
That is one of the reasons to i want to stop these medicines.the pain is slightly less now.
doctor
Answered by Dr. Seikhoo Bishnoi (3 minutes later)
Brief Answer:
Fatty liver is a reversible condition

Detailed Answer:
Hello thanks for asking again

Grade 1 fatty liver is not a serious issue. Even with short term intake of any drug that is metabolised by liver slight fatty changes in liver can be seen. The condition is totally reversible and no need to worry. You have reduced the doses already so in follow up USGs everything will come normal.

For liver herbal medicines like Liv 52 can be used. This is a syrup formulation and when taken regularly this will help to quick recovery. Discuss with your doctor regarding this.

Thanks, Still have more doubts please ask again.
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Seikhoo Bishnoi (6 minutes later)
Thanks and i will do that.But for now,tapering the doses of my current medications and stopping it could help right.So should i stop my medicines completely?
doctor
Answered by Dr. Seikhoo Bishnoi (1 minute later)
Brief Answer:
Yes the doses can be stopped after proper tapering

Detailed Answer:
Hello again

Yes taper the doses and then you can stop the drugs completely. Please if possible discuss with your old psychiatrist.

Thanks
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Dr. Seikhoo Bishnoi

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What causes headaches and weakness post Depakote and Paliperidone withdrawal?

Brief Answer: Gradual dose reduction would prevent any significant withdrawal symptoms. Detailed Answer: Hello thanks for choosing HCM for your health related queries I can understand your concern. You are a 42 years old healthy female with no current severe psychological stressor. You are on Depakote 250 (Divalproate), Paliperidone 1.5 and Buspirone 5 mg since about 2 years. You are currently stable and settled now, but when ever you try to stop medicines you get bad headaches and weakness as withdrawal symptoms. First of all I would like to tell you that the doses of medicines you are taking are very low doses and withdrawal from these doses would not be very severe. You have already reduced the doses and with proper tapering you can stop using these medicines easily. The symptoms of withdrawal you are having are probably due to psychological dependence and not due to physical dependence. So you have to accept this thing before tapering the doses that you might have some withdrawals but these withdrawals will not progress to severity, and are due to psychological dependence most likely. You are taking three medicines so first goal to stop these medicines should be to stop at least one drug out of these three. In my opinion you should start with Depakote. Continue to take the doses of other drugs as per your regular dosing and reduce the dose of Depakote to 125 mg for at least 4 weeks. After 4 weeks stop taking Depakote. Then wait for at least 2-4 more weeks and then reduce the dose of Paliris by taking the tablet on every alternate days for at least 4 weeks and then stop the drug completely. Lastly reduce the dose of Buspirone in same manner. If during course of tapering the doses you suffer worsening of any symptoms then medicines like low dose benzodiazepines can help. Low doses of Etizolam or Oxazepam can help you to beat the withdrawal symptoms. Take these drugs on SOS basis. Consult your doctor for prescription of these drugs. Tapering of doses in this manner will be easier and you can come out of dependence. Try to understand the fact that the doses you are taking are very low and tapering the doses would not cause any serious harm to you. During course of tapering of doses take healthy food rich in proteins and complex carbs and low in fats. Concomitant use of Omega-3-Fatty Acids will also lessen the symptoms. Thanks, I hope this helps you. Please don't hesitate to ask again for more doubts or if you want to clarify something from my answer. Take care