If you are 18 or over, the doctor can prescribe sodium valproate (as Episenta) or valproate semisodium (as Depakote and other brands) for you as a licensed medicine for mania that occurs with bipolar disorder. All sodium valproate products - but not valproate semisodium - are licensed to treat epilepsy.
Other preparations of sodium valproate (such as the brand Epilim) are very commonly used 'off-label' for mania. This is often due to the fact that liquid forms are available which make for easier swallowing. Valproate is likely to be used longer term to help prevent the return of symptoms of mania, and this is now recognised as within licensed use so long as the product chosen is not just licensed for epilepsy.
Sodium valproate can also be used 'off-label' to treat other conditions such as severe aggression.
Outside of its use in the treatment of epilepsy, there is less research on its effectiveness in young people under 18. Even so, specialists might prescribe it ‘off-label’ if they believe it is the best medicine for you.
N.B. Valproate must no longer be used in any woman or girl able to have children unless she has a pregnancy prevention programme in place. This is designed to make sure patients are fully aware of the risks and the need to avoid becoming pregnant. For more information, please read the guidance provided by the Government on the use of valproate by women and girls.
Valproate helps to treat the symptoms of mania (being very excited, overactive, easily irritated or distracted) in people with bipolar disorder. It is also used to prevent these symptoms from coming back.
With bipolar disorder, a person's mood changes from very high (mania) to very low (depression). Valproate is less effective at preventing the symptoms of depression in bipolar disorder from returning, but there are other medicines that can help with this.
Valproate is a type of medicine called a mood stabiliser as it reduces feelings of excitability and over-activity and reduces mood swings.
Medicines like valproate can keep your mood stable (stop it going too high or too low).
We do not fully understand how valproate works for mania and bipolar disorder, but we have some ideas about it.
Valproate blocks the breakdown of a chemical in the brain called gamma-aminobutyric acid (GABA). GABA is a chemical that calms nerve excitability in the brain. If valproate blocks its breakdown, there is more GABA to create this calming effect.
There are gateways in the brain called ‘sodium channels’, which can be open or closed. When they are open, chemicals go through that can make us excited.
Valproate may also work by locking on to closed sodium channels and keeping them closed. Sodium cannot pass through, which reduces nerve excitement.
If you are having a manic episode the doctor is likely to increase your dose quite quickly over a few days.
It usually only takes a few days for valproate to start working and to have its best effect.
Your dose is likely to be reduced in the longer term to get the best effect for you. This is because you are unlikely to need the same high dose as you would in a manic episode to provide longer-term benefit.
Your weight can be affected by valproate.
Valproate can make some people feel hungrier than usual. If you are eating more than usual, you can put on weight.
It is very difficult to know how it will affect each person who takes it.
Talk to your doctor about this if it worries you.
Healthy eating and exercise can prevent weight gain. Exercise is also good at helping with your mood.
You may want to let your family and friends know you are taking valproate so they can support you and help you look out for side effects.
For guidance on this, check out our page on getting support with your medication.
You should be careful drinking alcohol while taking valproate. Alcohol can affect your liver function, and so can valproate. Drinking alcohol can lead to mood swings and make your symptoms worse.
Alcohol can also make you sleepy and taking it with valproate can make this worse.
Make sure you go for your blood tests while you are taking valproate, to check that your liver is working properly.
If you do drink with valproate, make sure that it is small amounts and there's someone to look out for you.
Liquid formulations contain sorbitol and saccharin, while the syrup additionally contains sugar and should be avoided if you have diabetes.
You may feel sleepy, confused or dizzy when you start taking valproate, which may affect your concentration when doing things like driving a car or riding a bike. It might be best to stop driving, riding a bike or doing anything that requires a lot of focus for the first few days, until you know how it affects you.
Don't worry - most people do all these things as normal while taking valproate.
You must tell the DVLA if you have bipolar disorder or any other mental health condition that could affect your driving. You can be fined up to £1,000 if you do not tell DVLA about a medical condition that affects your driving. You may also be prosecuted if you are involved in an accident as a result.
Pregnancy
Is it safe to take valproate during pregnancy? The short answer is a definite NO.
If you and your partner are trying to have a baby, you should go back to the doctor to discuss other treatment options.
If you do become pregnant while you are taking valproate, you should go back to your doctor as a matter of urgency. They are likely to need to change you to another medicine and carefully stop your valproate.
Taking valproate during pregnancy can seriously affect unborn babies - about 10% (one in ten) may get a birth defect such as spine problems, and one in three babies may get a serious development disorder (e.g. autism, learning disability or ADHD).
Breastfeeding
Valproate can be passed to the baby via breast milk but the levels are generally very low, so the risk of side effects in the baby is also low.
It is generally thought that it is alright to breastfeed while taking valproate, but as everyone is different it is important to seek advice from your doctor or midwife first.
Remember that it is important for you to remain well while you are bonding with and looking after your baby. For this reason, it may be best to take medicine for your mental health when breastfeeding. Make sure that your doctor, nurse, or health visitor checks your baby for any side effects if you are taking valproate while breastfeeding.
It is less likely there will be any long term effects on your baby if you only take valproate during breastfeeding.
If your baby was premature or has health problems, then you will need to be extra careful about taking medicines while breastfeeding. It may be best not to breastfeed if this is the case, however you should discuss this with your doctor or midwife.
If you start valproate while breastfeeding, you must be using contraception as part of the Valproate Pregnancy prevention Programme.
Sex
Valproate can have side effects that may affect your sex life. These include:
If these effects persist and are a problem for you, go back to the doctor and see what else you could try.
However, the good effects of valproate may have a positive impact on your sex life as your symptoms settle, and you can concentrate on your relationships.
Fertility
Valproate has been shown to reduce fertility in men.
In young women, valproate can cause polycystic ovary syndrome (PCOS), which can lead to future infertility.
Valproate should NOT be taken by girls or women who could get pregnant unless they are on the Valproate Pregnancy Prevention Programme (Prevent). It is therefore important if you are having sex that you use good contraception every time.
If you want to try for a baby, you should go back to your doctor and talk about your treatment options and the risks and benefits.
Valproate is not a banned substance in sport.
Taking valproate may affect your ability to do things like riding a bike, competitive gymnastics, or anything else that needs a lot of focus. It might be best to stop such sports for the first few days, until you know how it affects you.
Don't worry - most people play sports as normal while taking valproate.
Valproate can make you feel sleepy or confused in the first few weeks that you take it, so try not to take it for the first time just before your exams.
You should talk to your doctor about any future exams if you are starting valproate. You might decide together to delay starting it until you have done them. If they are more than a month away, however, you might find that it is better to start valproate to improve your motivation to study.
Don't worry - most people take exams as normal while taking valproate.
You need to talk to your doctor or pharmacist before starting treatment with valproate if any of the following apply to you:
You will need to take valproate for several months after you feel better, otherwise your symptoms can come back.
Your doctor will advise you how long you'll need to stay on valproate, as it depends on what you are taking it for. If you are taking it to prevent the symptoms of mania from coming back, it might be about six months.
If you stop taking the valproate too soon, there is more chance that your symptoms will come back.
You will get the most benefit from your valproate if you take it every day.
Make sure that you know your dose. If it is not written on the label, check with your pharmacist or doctor.
Valproate semisodium is normally taken twice a day but sometimes it may be three times a day.
The starting dose is normally 750mg per day but will probably be increased to between 1000mg and 2000mg a day.
Sodium valproate is available as ‘controlled-release’ (also called ‘prolonged-release’) tablets, capsules and granules that mean you only need to take it once a day.
The controlled-release capsules or tablets should be swallowed whole with a glass of water and not crushed or chewed.
The controlled-release granules can either be sprinkled on a small amount of soft cold food, taken in a drink, or poured directly into the mouth and washed down with a cold drink. If the granules are added to a drink, after you’ve had the drink the glass should be rinsed with a small amount of water and you should drink this water as well, as some granules may stick to the glass. The granules should not be crushed or chewed.
Controlled-release medicines might help you if you find it difficult to remember all the doses and would otherwise need to take doses at school, university or work.
Valproate can be taken with or after a meal. Taking it with food can help to reduce the chance of feeling sick. Not everyone feels sick with valproate, but this is one of the possible side effects.
Some of the valproate preparations have a special coating (“enteric” or “gastro-resistant” coating) to protect the tablet from stomach acid. This tablet should be swallowed whole with a glass of water - do not chew it as it tastes bitter and you will break the protective coat.
If you remember later during the day, take it as soon as you remember - unless you are less than four hours away from your next dose. If you forget to take it by then, just start again with the next dose.
Do not take a double dose.
If you forget to take it for a few days, you may start getting your symptoms back and should talk to your doctor about it.
Once you start taking valproate, the brain adjusts to having its calming effect. If you stop taking the valproate all at once, the chemical balance in your brain starts to change again, meaning you could get your old symptoms back.
However, you can stop taking valproate safely with your doctor’s help.
Go and speak to your doctor if you have missed a few doses or have decided to stop taking your medication.
When you agree with your doctor to stop the medicine, you will carry on with a dose that gradually decreases over about a month.
If you have taken more valproate than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different.
Valproate can make some people think about hurting themselves or taking their own lives. You must go straight to hospital with your tablets if you have any of these thoughts.
Valproate can sometimes cause other rare but serious side effects: allergic reactions (difficulty breathing, swelling of your face or throat, itching skin lumps), problems with your liver or pancreas (suddenly feeling weak, not wanting to eat, feeling sleepy or confused, severe stomach pain, feeling or being sick, or the whites of your eyes changing to yellow) and problems with your blood cells (which might show as bruising, getting more infections than usual, a sore throat, feeling weak, tired, dizzy or having very pale skin). Go to a hospital with your medicine if you get any of these symptoms.
Stopping valproate suddenly can cause symptoms to return. If you are thinking of stopping or want to stop, talk to your doctor first.
You might feel sleepy in the first few days after taking valproate. Do not drive a car, ride a bike or operate machines until you see how this affects you.
If you are pregnant, or thinking of becoming pregnant, please read the question about pregnancy in the FAQ section above. Valproate is very likely to affect the developing baby. Valproate can cause serious harm to a developing baby and should no longer be prescribed to women and girls who are able to have babies unless they are on the valproate pregnancy prevention programme (Prevent).
If you have taken more valproate than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different. Go to A&E. Take your medicine with you to show to the doctors. Tell them how much you have taken. Get a friend to go with you, if you can, just in case you feel ill on the way.
You might get any of the following signs:
While taking valproate, some people may think about hurting themselves or taking their own lives. This can happen to anyone, including people who are under 18. You must go straight to hospital with your tablets if you have any of these thoughts. You must tell the doctor that you are taking valproate.
Stop taking valproate and go to a doctor or hospital straight away if you get any of the following allergy symptoms:
Stop taking valproate and go to a doctor or hospital straight away if you get any of the following symptoms (which may be signs of a problem with your liver or pancreas):
Stop taking valproate and go to a doctor or hospital straight away if you get any of the following symptoms (which may be signs of a problem with your blood cells):
Very common side effects (affecting more than one in ten) include:
Common side effects (affecting up to one in ten) include:
Keep taking your tablets, but tell your doctor as soon as possible if you get any of the following side effects:
