Initial Lithium and Valproate Combination Therapy in Acute Mania

Abstract

Early onset of treatment efficacy is especially important for severe mania syndromes. Lithium has usually a delayed onset of response, which is disadvantageous for inpatient treatment of severe mania. Valproate is effective in treating acute mania and has sedative properties. It has, however, a response rate of approximately only two thirds. Therefore, the initial combination of valproate and lithium was evaluated in a prospective case series of 12 patients, and a retrospective analysis was carried out for 5 patients in comparison with a pretreatment period when lithium therapy was applied without valproate. Outcome criterion for analysis was the latency of response and remission, as well as the amount of neuroleptics used for additional sedation. Patients had a mania syndrome-severity score comparable with the mean mania score of the bipolar manic patients treated in the same unit. All patients under the combination treatment responded. The response occurred within a shorter time compared with the lithium pretreatment episode, which is statistically marginally significant, and the use of neuroleptic medication could be markedly reduced from 18,601.6 mg chlorpromazine equivalents to 3,927.6 mg (p < 0.025). The initial valproate-lithium combination therapy seems to be a safe and effective way to treat severe mania syndromes in the clinic.

Prevalence and clinical correlates of residual symptoms in remitted patients with bipolar disorder: An exploratory study

“…Available evidence suggests use of combination of mood stabilizers in cases of patients with treatment-resistant mania. [ 52 53 54 ] Use of clozapine in treatment-refractory manic cases is well established,[ 55 56 57 58 59 60 ] yet it lacks the regulatory approval for use in any phase of BD. [ 61 ] In the present study too, clozapine was found to be more often used in those with manic residual symptoms when compared with other two groups with residual symptoms, possibly suggesting these to be treatment-refractory cases.…”

Cross-species assessments of motor and exploratory behavior related to bipolar disorder

“…Second, bipolar mania is characterized by a broad set of symptoms and not all manic individuals exhibit motor hyperactivity (Einat, 2007b). Third, while acute lithium treatment has been demonstrated to attenuate amphetamine-induced hyperactivity in rodents (Berggren et al, 1981), the specificity of this effect is debatable and the therapeutic effect of lithium in bipolar patients may not appear for weeks (Reischies et al, 2002). …”

Sleep and circadian rhythms in children and adolescents with bipolar disorder

“…The most commonly used pharmacological interventions for bipolar disorder are antidepressants, lithium, the anticonvulsants~e.g., carbamazepine and lamotrigine!, and the novel antipsychotics~e.g., olanzapine; Grunze, 2005;McIntyre, 2002!. Most of these medications have an impact on sleep. Typically they are either sedating Ghaemi, Manwani, Katzow, Ko, & Goodwin, 2001;Makela, Miller, & Cutlip, 2003;McIntyre, 2002;Reischies, Hartikainen, & Berghofer, 2002;Sorge, Pollmaecher, & Lancel, 2004! and0or alter sleep architecture~Bazil, 2003Gann, Riemann, Hohagen, Muller, & Berger, 1994;Geurkink, Sheth, Gidal, & Hermann, 2000;Kupfer, Wyatt, Greenspan, Scott, & Snyder, 1970;Sharpley, Vassallo, & Cowen, 2000;Sharpley, Walsh, & Cowen, 1996!.…”