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Compare Depakote vs. Lithium

Head-to-head comparisons of medication uses, side effects, warnings, and more.

Key takeaways

Divalproex (Depakote) and lithium (Lithobid) are both used to treat bipolar disorder, but they belong to different medication classes. Divalproex is an antiepileptic, while lithium is an antimanic. Divalproex is also used to treat seizures and prevent migraines, whereas lithium is specifically for treating manic episodes and long-term maintenance of bipolar disorder. Divalproex comes in various forms, including delayed-release tablets, extended-release tablets, and sprinkle capsules, and is typically taken once or twice daily. In contrast, lithium is available as instant-release pills, oral liquid, and extended-release tablets, and is usually taken 2 to 3 times a day. Both medications require regular blood tests to monitor their levels and potential side effects, due to a risk of toxicity if levels become too high. Common side effects of divalproex include nausea, sleepiness, and dizziness. Lithium can also cause nausea, sleepiness, and dizziness, as well as increased thirst, and frequent urination. Neither medication is recommended during pregnancy due to potential risks to the fetus.

Divalproex (Depakote)
Lithium
Divalproex (Depakote)
Lithium
Summary of Depakote vs. Lithium
Summary for Antiepileptic
Prescription only
Divalproex (Depakote) is a prescription medication that's used alone or in combination with other medications to treat certain types of seizures. It can also be used to prevent migraines and treat bipolar disorder. Divalproex (Depakote) comes in delayed-release (DR) and extended-release (ER) tablets, as well as sprinkle capsules. You take it by mouth, typically once or twice daily, depending on the formulation. Divalproex (Depakote) can cause changes in weight, both in weight loss and weight gain. Don't suddenly stop taking this medication since it can raise your risk of withdrawal symptoms, including seizures.
Summary for Antimanic
Prescription only
Lithium carbonate (or lithium) is a medication used to treat bipolar disorder and manic episodes. It's taken by mouth, typically 2 to 3 times a day. Lithium is available as instant-release pills and oral liquid as well as an extended-release tablet (brand name Lithobid). All lithium products are available as lower-cost generics. Lithium works well for treating bipolar disorder, but it can also cause side effects, such as shakiness, thirst, and nausea. To prevent lithium toxicity, your provider will check your blood lithium levels to make sure you're on a safe dose of the medication.
Indications of Depakote vs. Lithium
Indications for

•Bipolar disorder

•Seizures (focal impaired awareness seizure, absence seizure)

•Migraine prevention

Indications for

•Treatment of manic episodes of bipolar disorder

•Long-term maintenance treatment of bipolar disorder
Pros and Cons of Depakote vs. Lithium
Pros and Const for Antiepileptic
Pros

•Available as a lower-cost generic

•Dose can be adjusted based on your response

•Available in various forms: delayed-release tablets, sprinkle capsules, and extended-release tablets

•Can be used on its own or with other medications to control seizures

Cons

•Can prevent migraines from happening, but it won't help if you have a migraine attack

•Interacts with many medications, such as phenytoin (Dilantin)

•Can’t take while pregnant

•Requires regular blood work and lab tests to make sure your liver is healthy

Pros and Const for Antimanic
Pros

•Works well for bipolar disorder

•Starts to work in about 1 to 3 weeks

•Available as a lower-cost generic

•Available as oral pills and oral liquid for those having trouble swallowing pills

Cons

•Can have a lot of side effects, including lithium toxicity if lithium levels are too high

•Requires routine blood tests to check the medication levels and how the medication is affecting your body

•Not the best option for people with severe kidney problems

•Interacts with a lot of medications such as non-steroidal anti-inflammatory drugs (NSAIDs), diuretics, and ACE-inhibitors
Common Side Effects of Depakote vs. Lithium
Common Side Effects for
Bipolar disorder

•Nausea (22%)

•Excess sleepiness (19%)

•Dizziness (12%)

•Vomiting (12%)

•Accidental injury (11%)

•Low energy (10%)

Seizures

•Nausea (48%)

•Headache (31%)

•Feeling weak (27%)

•Vomiting (27%)

•Tremor (25%)

•Dizziness (25%)

•Stomach pain (23%)

Migraine

•Nausea (31%)

•Feeling weak (20%)

•Excessive sleepiness (17%)

•Indigestion (13%)

•Diarrhea (12%)

•Dizziness (12%)

•Vomiting (11%)

Common Side Effects for
Adults:

•Hand trembling

•Excessive urination

•More thirst

•Nausea

•General discomfort when you start treatment

Children (7 to 17 years of age):

•Nausea or vomiting (57%)

•Urinating more often (38%)

•Tremor (32%)

•Feeling more thirsty (28%)

•Tiredness (26%)

•Higher thyroid hormone levels (25%)

•Dizziness (23%)
Warnings of Depakote vs. Lithium
Common Side Effects for

•Liver problems

•Serious birth defects

•Serious pancreas problems

•Suicidal behavior and thoughts

•Lower blood cell counts

•Higher ammonia level in blood

•Severe skin and allergic reactions

•Interaction with other medications

Common Side Effects for

•Lithium toxicity

•Kidney problems

•Serotonin syndrome

•Thyroid problems

•Heart problems (Brugada syndrome)

•Low blood sodium levels

•High blood calcium levels and high parathyroid hormone levels

•Brain-related side effects
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Compare Depakote vs. Lithium

Key takeaways

Summary of Depakote vs. Lithium

Indications of Depakote vs. Lithium

Pros and Cons of Depakote vs. Lithium

Common Side Effects of Depakote vs. Lithium

Warnings of Depakote vs. Lithium

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