A 20-Month, Double-Blind, Maintenance Trial of Lithium Versus Divalproex in Rapid-Cycling Bipolar Disorder

• DOI: 10.1176/appi.ajp.162.11.2152
• Publication Date: 2005-11-01T15:47:49Z
• Authors: Joseph R. Calabrese; Melvin D. Shelton; Daniel J. Rapport; Eric A. Youngstrom; Kelly Jackson; Sarah Bilali; Stephen J. Ganocy; Robert L. Findling
• Keywords: Divalproex; Hypomania; Mood stabilizer; Bipolar II disorder; Bipolar I disorder

OBJECTIVE: The authors tested the hypothesis that divalproex would be more effective than lithium in long-term management of patients with recently stabilized rapid-cycling bipolar disorder. METHOD: A 20-month, double-blind, parallel-group comparison was carried out hypomanic/manic who had experienced a persistent bimodal response to combined treatment and divalproex. Sixty were randomly assigned or monotherapy balanced design after stratification for illness type (bipolar I versus II disorder). RESULTS: Of 254 enrolled open-label acute stabilization phase, 76% discontinued study prematurely (poor adherence: 28%; nonresponse: 26% [of whom 74% remained depressed hypomanic/manic/mixed episode], intolerable side effects: 19%). 60 (24%) double-blind maintenance monotherapy, 53% relapsed (59% into depression 41% episode), 22% completed study, 10% effects, poorly adherent. rates relapse any mood episode those given 56% 50%, respectively; 34% 29% depressive 19% hypomania/mania relapse. There no significant differences time proportion discontinuing because effects 16% 4% CONCLUSIONS: is disorder not supported by these data. Preliminary data suggest highly recurrent refractory may hallmark