Depakine

Depakine is the new medication Rajid proposes for Emma after she reports hallucinations and delusions and has an adverse reaction to Tegretol. Added to lithium, it is intended to reduce manic episodes and, in Rajid’s account, the associated delusions and hallucinations. Its introduction brings treatment, observation, and the possibility of going home into direct tension: Emma must manage emerging side effects while Rajid weighs her progress against the danger of sending her home before she is stable.

Proposed Role in Emma’s Treatment

Rajid first raises Depakine after Emma has described experiences that lead him to think bipolar disorder may explain her symptoms. He wants to wait until the effects of Tegretol have completely passed before starting it. The interval is not meant to be empty: he proposes using it to complete mood forms, which could help establish how often Emma’s episodes occur and whether particular triggers are involved. He also urges her to discuss what she has disclosed with Lars, since the experiences appear to have a substantial impact on her life and she has been carrying them alone.

Later, Rajid explains the treatment in terms of rapid cycling. He presents that pattern as difficult but not hopeless, saying that some medicines used with lithium can reduce mood swings in both duration and frequency. Tegretol, another anti-epileptic medication, has caused Emma adverse effects; Depakine works differently, and Rajid wants to try it alongside lithium. He proposes starting over the weekend and keeping Emma in hospital for at least two weeks while the dose is built up, possibly longer. The reason is practical and protective: he does not want her to leave with a new medication before its effects are known.

Starting the Medication and Monitoring Its Effects

By Sunday evening, Emma and her care team have begun the Depakine. When side effects emerge, she records a dry mouth, headache, and trembling hands. She is still alive, a fact that briefly registers as a gain, but the thought does not hold its reassuring force. The physical discomfort is only one part of the scene: while she works on a puzzle, distraction gives way to the return of depression when the ward quiets and other people go to bed.

At night, the contrast between outward activity and inward distress becomes especially stark. Emma can direct her attention toward the puzzle and other patients for a time, but once that distraction falls away, depression returns with a force she likens to ice breaking beneath her. Laughter hurts; company sharpens her sense of what she cannot feel. She anticipates Sergei’s visit and the familiar touch of his hand, yet fears that she will feel nothing because grief and depression have left her without room for love. The final puzzle piece does not restore a coherent picture: she no longer knows what the completed image represents, and the corner she lifts crumbles beneath her fingers. Depakine’s arrival coincides with this low point, but the account does not establish that the medication caused her depression or emotional numbness.

The question of which pills are being discussed also matters. When Rajid asks about Depakine’s side effects, Emma hesitates and clarifies that she means the pills Sergei was supposed to throw away. Those are separate from the new treatment. Rajid’s question exposes a potentially consequential misunderstanding: Emma’s reference to pills concerns the medication she had stockpiled, not an adverse reaction to Depakine.

Dose Increases, Mood Forms, and Discharge

During a later appointment, Rajid says Emma is doing well with Depakine and that her dose must be raised once more that week to reach the intended level. Asked about side effects, she reports that her hands still tremble and her mouth is sometimes dry, but says she can tolerate them. Rajid regards the course so far as promising, though the process remains unfinished and requires further monitoring.

The mood form complicates any simple account of improvement. Rajid traces its line to the latest mark, which remains below the midpoint, and points out that Emma is still depressed. He also asks whether the delusions and hallucinations persist. The chart makes visible a distinction between tolerable physical effects from the medication and the unresolved state of Emma’s illness: a dose can be progressing as planned even while her mood remains low.

That distinction shapes the discharge discussion. Rajid is troubled by the idea of sending Emma home while she remains unwell and wants the depression to pass and her to become stable before leaving. Her previous intention to take all her pills weighs on him; he cannot accept a plan that would leave her exposed to that risk. Emma, meanwhile, recognizes the burden of being seen as a patient for whom Rajid is responsible and whom he might need to protect from herself. She does not deny that this is part of her life, but insists that she must also live it herself. Depakine therefore becomes part of a negotiated question of timing: treatment may be proceeding, yet neither the new dose nor the prospect of discharge resolves the tension between clinical caution and Emma’s claim to agency.

Medication and Beatrice’s Loss of Religious Feeling

The book places Depakine and lithium in another emotionally charged scene when Emma returns from collecting pills to find the communal room empty and the ward unsettled. A garbage bag flaps in the damaged door; she feels that the shards have cut people off from themselves and one another. The two medicines settle against her stomach as she describes her mind as dark and empty. The scene links medication to the physical routine of treatment and to the ward’s atmosphere, but it does not say that either drug causes her despair.

Elsewhere, Beatrice recounts that during an earlier hospital stay she began taking pills and, after three days, could no longer feel God’s presence. She had gone home believing that stopping the pills might bring that presence back, but it did not; she eventually returned to the PAAZ. Her account makes the loss of religious feeling central to her loneliness, especially in the context of the death of her young son. The medication in this recollection is not identified as Depakine, so the narrative does not establish that Depakine produced the change.

Emma initially realizes that she has not made much effort to understand Beatrice’s experience. When Beatrice asks whether Emma knows what it feels like, Emma says she does not, then offers two possibilities without claiming certainty: perhaps depression itself has swallowed Beatrice’s capacity to feel faith, or perhaps that feeling will return as the depression recedes. The exchange preserves the uncertainty between medication and illness rather than turning Beatrice’s story into proof of a drug effect. In this wider context, Depakine belongs to a treatment process whose effects are watched closely, while the human meanings attached to taking pills remain individual and unresolved.