mood stabilizers and sexual side effects

[cherryalmond]

So I do not usually post on here about patients but I am a fairly new attending and do not get much supervision at my job. I do plan on seeking supervision for this one but am curious about others experience.
I have a patient on depakote and zyprexa---he was on this when i inherited him, and he is doing fairly well. bipolar d/o, most recent ep in june '12, severe mania with psychosis. he was very sick. he was stabilizd on the meds he is on now. he is doing well, working, relationships going well, high functioning. anyway he has been complaining of sexual side effects from depakote for the past few months but he has been dealing with it but now he wants to switch off depakote. he knows it is from the depakote because it has happened to him in the past when he was only on depakote. oh also he is on depakote ER.
I am hesitant to switch him but mostlikely will. my question is which mood stabilizer should i go for, which one has the least reported sexual side effects. he has been experiencing impotence with depakote. would switching to immediate release depakote help? i'm thinking lamictal or tegretol; he can't take lithium-i don't remember why. Oddly this issue with sexual side effects and mood stabilizers never came up in my residency training, but i guess a lot of patients are embarassed to report it.
thanx

---

Members don't see this ad.

 

[LimbicResponse]

Have you tried to spend some time exploring the impotence. Are you certain it's a pharmacological side effect and not medical or psychological ?

Have you considered adding Sildenafil or a similar alternative ?
-I would be hesitant switching a patient that is currently stable and doing well on Depakote to an inferior medication. You mentioned he was high functioning , he may not like the cognitive effects of your alternatives even if they end up keeping him euthymic. (Caveat: I'm a medical student so I have no clue what I'm talking about)