Pattern of Response to Divalproex, Lithium, or Placebo in Four Naturalistic Subtypes of Mania

Swann, Alan C.; Bowden, Charles L.; Calabrese, Joseph R.; Dilsaver, Steven C.; Morris, David

doi:10.1016/s0893-133x(01)00390-6

Cited by 124 publications

(86 citation statements)

References 20 publications

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“…Based on secondary analyses from the comparative trials with olanzapine and the comparative trial with lithium and placebo by Bowden and co-workers Swann et al 2002) and the study by McElroy et al (1996a) comparing valproate with haloperidol, albeit small in sample size, there are indications that valproate also works in psychotic mania.…”

Section: Valproatementioning

confidence: 99%

The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2009 on the Treatment of Acute Mania

Grunze

Vieta

Goodwin

et al. 2009

The World Journal of Biological Psychiatry

316

247

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These updated guidelines are based on a first edition that was published in 2003, and have been edited and updated with the available scientific evidence until end of 2008. Their purpose is to supply a systematic overview of all scientific evidence pertaining to the treatment of acute mania in adults. The data used for these guidelines have been extracted from a MEDLINE and EMBASE search, from the clinical trial database clinicaltrials.gov, from recent proceedings of key conferences, and from various national and international treatment guidelines. Their scientific rigor was categorised into six levels of evidence (AÁF). As these guidelines are intended for clinical use, the scientific evidence was finally asigned different grades of recommendation to ensure practicability.

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Section: Valproatementioning

confidence: 99%

The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2009 on the Treatment of Acute Mania

Grunze

Vieta

Goodwin

et al. 2009

The World Journal of Biological Psychiatry

316

247

View full text Add to dashboard Cite

show abstract

“…However, a plausible mechanism for the worsening of depression, we observed in the initially euphoric manic patients treated with lithium is not selfevident. The consistently observed motor slowing consequent to lithium use in healthy control and bipolar patients might contribute to higher depression scores in patients who are no longer in a manic episode, with its attendant elevated energy and hyperactivity (Shaw et al, 1987;Swann et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

Relationship of Mania Symptomatology to Maintenance Treatment Response with Divalproex, Lithium, or Placebo

Bowden

Collins

McElroy

et al. 2005

Neuropsychopharmacol

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Euphoric and mixed (dysphoric) manic symptoms have different response patterns to divalproex and lithium in acute mania treatment, but have not been studied in relationship to maintenance treatment outcomes. We examined the impact of initial euphoric or dysphoric manic symptomatology on maintenance outcome. Randomized maintenance treatment with divalproex, lithium, or placebo was provided for 372 bipolar I patients, who met improvement criteria during open phase treatment for an index manic episode. The current analysis grouped patients according to the index manic episode subtype (euphoric or dysphoric), and evaluated the impact on maintenance treatment outcome. The rate of early discontinuation due to intolerance during maintenance treatment was higher for initially dysphoric patients (N ¼ 249) than euphoric patients (N ¼ 123; 15.7 vs 7.3%, respectively; p ¼ 0.032). Both lithium (23.2%) and divalproex (17.1%) were associated with more premature discontinuations due to intolerance than placebo (4.8%; p ¼ 0.003 and 0.02, respectively) in the initially dysphoric patients. Among initially euphoric patients, treatment with lithium was associated with significantly more premature discontinuations due to intolerance compared to placebo (18.2 vs 0%; p ¼ 0.03), and divalproex was significantly (p ¼ 0.05) more effective than lithium, but not placebo in delaying time to a depressive episode. Initial euphoric mania appeared to predispose to better outcomes on indices of depression and overall function with divalproex maintenance than with either placebo or lithium. Dysphoric mania appeared to predispose patients to more side effects when treated with either divalproex or lithium during maintenance therapy.

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“…Divalproex is equally effective in those with classical and dysphoric mania. Further, divalproex is recommended for those with multiple prior episodes, predominant irritable or dysphoric mood and/or comorbid substance abuse or those with a history of head trauma 188, 191, 192, 193, 194, 195. Because of its teratogenic potential, however, caution should be exercised when prescribing divalproex to women of childbearing age.…”

Section: Acute Management Of Bipolar Maniamentioning

confidence: 99%

“…There is no evidence of superiority of any first‐line monotherapy treatment in comparison to other monotherapy options in treating patients with psychotic features. Similarly, there is no evidence that any first‐line combination therapy of lithium or divalproex plus an atypical antipsychotic is more effective than other first‐line combination therapy 174, 193, 213, 214. However, clinical experience suggests that the combination of lithium or divalproex plus an atypical antipsychotic is more appropriate for manic patients with mood‐incongruent psychotic features (ie, other than grandiose delusions).…”

Section: Acute Management Of Bipolar Maniamentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Pattern of Response to Divalproex, Lithium, or Placebo in Four Naturalistic Subtypes of Mania

Cited by 124 publications

References 20 publications

The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2009 on the Treatment of Acute Mania

The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2009 on the Treatment of Acute Mania

Relationship of Mania Symptomatology to Maintenance Treatment Response with Divalproex, Lithium, or Placebo

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

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