This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Treatment Response to Lithium or Divalproex

Alan C. Swann, MD; Charles L. Bowden, MD; David Morris, PhD; Joseph R. Calabrese, MD; Frederick Petty, MD, PhD; Joyce Small, MD; Steven C. Dilsaver, MD; John M. Davis, MD

Arch Gen Psychiatry. 1997;54(1):37-42.

Abstract
Background
Little information exists from controlled studies about clinical characteristics that predict treatment response in mania. The presence of depressive symptoms during manic episodes may be associated with poor response to psychopharmacological treatments. This is an investigation of the relation between depressive symptoms and treatment response in acute manic episodes.

Methods and Design
In a parallel-group, doubleblind study, 179 patients hospitalized for acute manic episodes were randomized to receive divalproex sodium, lithium carbonate, or placebo (ratio, 2:1:2). The study was carried out at 9 academic medical centers. Patients had comprehensive evaluations of behavior and symptoms before and during 3 weeks of treatment. The primary outcome measure, change in mania factor scores derived from the Schedule for Affective Disorders and Schizophrenia: Change Version, was compared in pa- tients with and without depressive symptoms at baseline according to nurse- or physician-rated scales.

Results
Depressive symptoms were associated with poor antimanic response to lithium and with better response to divalproex. This was not due to differences in overall severity of illness, substance abuse, gender, age, or history.

Conclusions
These data suggest that even a modest level of pretreatment depression-related symptoms is a robust predictor of lithium nonresponse, and is associated with better response to divalproex. Although their overall efficacy in acute mania is similar, lithium and divalproex may be most effective in clinically and biologically distinct groups of patients.

Author Affiliations
From the Department of Psychiatry, University of Texas Medical School at Houston (Drs Swann and Dilsaver); the Department of Psychiatry, University of Texas Health Science Center at San Antonio (Dr Bowden); Abbott Laboratories Inc, North Chicago, Ill (Dr Morris); the Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio (Dr Calabrese); the Department of Psychiatry, University of Texas Southwestern Medical School at Dallas (Dr Petty); the Department of Psychiatry, University of Indiana School of Medicine, Indianapolis (Dr Small); and the Department of Psychiatry, University of Illinois at Chicago (Dr Davis).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Adjunctive Antidepressant Use and Symptomatic Recovery Among Bipolar Depressed Patients With Concomitant Manic Symptoms: Findings From the STEP-BD
Goldberg et al.
Am. J. Psychiatry 2007;164:1348-1355.
ABSTRACT | FULL TEXT  

Mixed Hypomania in 908 Patients With Bipolar Disorder Evaluated Prospectively in the Stanley Foundation Bipolar Treatment Network: A Sex-Specific Phenomenon
Suppes et al.
Arch Gen Psychiatry 2005;62:1089-1096.
ABSTRACT | FULL TEXT  

Efficacy of olanzapine combined with valproate or lithium in the treatment of dysphoric mania
Baker et al.
Br. J. Psychiatry 2004;185:472-478.
ABSTRACT | FULL TEXT  

What Is a "Mood Stabilizer"? An Evidence-Based Response
Bauer and Mitchner
Am. J. Psychiatry 2004;161:3-18.
ABSTRACT | FULL TEXT  

Practice Guideline for the Treatment of Patients With Bipolar Disorder (Revision)
Hirschfeld et al.
Focus 2003;1:64-110.
FULL TEXT  

The co-morbidity of depression and epilepsy: Epidemiology, etiology, and treatment
Harden
Neurology 2002;59:S48-55.
ABSTRACT | FULL TEXT  

Syndromes and Phenomenological Subtypes Underlying Acute Mania: A Factor Analytic Study of 576 Manic Patients
Sato et al.
Am. J. Psychiatry 2002;159:968-974.
ABSTRACT | FULL TEXT  

Trends in the Treatment of Bipolar Disorder by Outpatient Psychiatrists
Blanco et al.
Am. J. Psychiatry 2002;159:1005-1010.
ABSTRACT | FULL TEXT  

Does the Manic/Mixed Episode Distinction in Bipolar Disorder Patients Run True Over Time?
Woods et al.
Am. J. Psychiatry 2001;158:1324-1326.
ABSTRACT | FULL TEXT  

The search for the wandering thymostat: a review of some developments in bipolar disorder research
FERRIER et al.
Br. J. Psychiatry 2001;178 :s103-s106.
FULL TEXT  

Evolving methodologies in bipolar disorder maintenance research
CALABRESE et al.
Br. J. Psychiatry 2001;178 :s157-s163.
ABSTRACT | FULL TEXT  

Developments in mood stabilisers: Depression and public health
Ferrier
Br Med Bull 2001;57:179-192.
ABSTRACT | FULL TEXT  

Lithium: The Oldest Specific Psychotropic Medication
JWatch Psychiatry 2000;2000:6-6.
FULL TEXT  

Identification and Characterization of N-Acetylcysteine Conjugates of Valproic Acid in Humans and Animals
Gopaul et al.
Drug Metab. Dispos. 2000;28:823-832.
ABSTRACT | FULL TEXT  

A Randomized, Placebo-Controlled 12-Month Trial of Divalproex and Lithium in Treatment of Outpatients With Bipolar I Disorder
Bowden et al.
Arch Gen Psychiatry 2000;57:481-489.
ABSTRACT | FULL TEXT  

A Preliminary Investigation of a Protein Kinase C Inhibitor in the Treatment of Acute Mania
Bebchuk et al.
Arch Gen Psychiatry 2000;57:95-97.
FULL TEXT  

Differential Effect of Number of Previous Episodes of Affective Disorder on Response to Lithium or Divalproex in Acute Mania
Swann et al.
Am. J. Psychiatry 1999;156:1264-1266.
ABSTRACT | FULL TEXT  

A Review of Bipolar Disorder Among Adults
Hilty et al.
Psychiatr. Serv. 1999;50:201-213.
ABSTRACT | FULL TEXT  

Classic Mania: Treatment Response to Divalproex or Lithium
Woods et al.
Arch Gen Psychiatry 1998;55:1050-1050.
FULL TEXT