Am J Psychiatry 1997; 154:1456-1458
Copyright © 1997 by American Psychiatric Association
Valproate prophylaxis in a prospective clinical trial of refractory bipolar disorder
KD Denicoff, EE Smith-Jackson, AL Bryan, SO Ali and RM Post
Section on Psychobiology, NIMH, Bethesda, MD 20892, USA.
OBJECTIVE: The authors studied the efficacy of valproate plus lithium and
of triple therapy with lithium, carbamazepine, and valproate in refractory
bipolar illness. METHOD: The subjects were 24 bipolar outpatients who had
completed an intended 3-year crossover study comparing lithium,
carbamazepine, and their combination. Patients entered a 1-year phase of
valproate plus lithium because of inadequate response or major side
effects, and patients with inadequate responses were offered an additional
year of treatment with all three mood- stabilizing drugs. RESULTS: Six
(33%) of the 18 evaluable patients had moderate to marked responses to
valproate plus lithium; four of these six had not responded to any previous
treatment condition. Three of seven patients responded to triple therapy,
although only one response was marked. CONCLUSIONS: Some outpatients with
bipolar disorder refractory to lithium and carbamazepine received
clinically relevant prophylactic benefit from valproate when used with
lithium or in triple therapy.
