I'm male, 44, diagnosed with bipolar type 2/seasonal at 19. I started Zepbound 6 weeks ago at 255 lbs and I'm down to 235 lbs. Height is 5' 10", white. Currently on Zepbound 5mg and lamotrigine 200mg AM/PM. I've been on lamotrigine ~15 years. I was on Depakote 1500mg for 7 years before tapering off.
Is it possible for the GABA production to still be recovering 25 days after Depakote cessation? If GABA production is down due to the brain relearning how to balance itself, then could high levels of cortisol could lead to high levels of glutamate creating the mood instability that looks like mania? If so, how long can I expect this to last? Will there be permanent "damage" due to Depakote usage or can the brain rewire itself?
Context:
Over the last year I've come to think I may have ADHD instead of bipolar. Depakote was killing me with brain fog. I had also been taking Adderall for concentration but noticed I couldn't function without it so I stopped that early March (which was rough). So with the supervision of my psychiatrist, I tapered off of Depakote from 1500mg to 0 over four weeks. My last dose was 25 days ago. As soon as I stopped I noticed some depersonalization, especially in stressful situations (my life is very stressful, sole parent to three teens and a pre-teen). The depersonalization/"third person perspective" has more or less become constant in the evenings (when I'm with my kids), and is now joined by painless headaches, eye socket cramps, overwhelm, "raw nerves," restlessness, and misdirected focus (either unable to focus on the important task or following a rabbit trail).
Despite that, my ability to self-regulate has improved off of the Depakote; when on Depakote I would occasionally have explosive destructive outbursts or yelling matches (it was like Depakote hindered my ability to process emotion rationally). Now, even though I feel in a constant state of overwhelm, I feel more in control of myself and my ability to regulate the big emotions. I'm more in control of my voice, how I treat my kids, whether or not I work (I have a puzzle beside my desk to cope with the moments when I'm distracted or need a break). What's bugging me is the depersonalization and the overwhelm. When I'm making supper, I can't handle it if my kids come to me with an argument or a problem so I just tell them I can't talk to them right now. The untidy house and garage really trigger me and I dread coming home because of the chaos (it's not unsanitary, just always untidy -- I don't have the bandwidth to teach everything so we pick our battles).
I haven't been eating enough in the last two weeks (as low as ~500 cal on some days, ~800 cal avg) because I feel full constantly. I wonder if the deficit in calories has contributed to the depersonalization and automatic "fight or flight" reactions.
My doctor seems to think I'm experiencing hypomania/mania and suggests I go back on Depakote. I am very opposed to this. I don't feel manic just constant overwhelm and overstimulation. I'm still on lamotrigine (if all goes well I'll taper off of it this winter or next year). My thinking is that after being on Depakote for 7 years my brain is learning how to self-regulate.
I have tried lithium, Latuda, Wellbutrin, Depakote, oxcarbazepine, lamotrigine (others?) in order to beat what my first doctor said was hypomania (anger, irritability). None of these worked except Adderall which is why I'm exploring ADHD. Adderall made me dependent which is why I quit it. On lithium at 1,200 mg I experienced toxicity 9 years ago (stroke-like, aphasia, loss of proprioception, I felt my teeth and limbs falling out/off).