Those with some--but less robustly demonstrated--antidepressant action include lithium, divalproex
, and carbarn azepine.
In a double-blind trial, DelBello et al (11) randomly assigned 50 patients age 12 to 18 with a bipolar I manic or mixed episode to quetiapine, 400 to 600 mg/d, or divalproex
, serum level 80 to 120 [micro]g/mL, for 28 days.
Three small placebo-controlled studies evaluated the use of divalproex
in the acute treatment of bipolar depression.
He conducted a chart review of 29 consecutive patients with Alzheimer's disease (mean age 77 years) who received divalproex
, in addition to their usual therapy for aggression/agitation, irritability aberrant motor behavior, disinhibition, and other behavioral disturbances.
9% Increase sertraline to 200 mg each morning 5% Increase divalproex
ER to 2,000 mg each evening 1% Add a second antidepressant 7% Add an atypical antipsychotic 78% Add 25 mcg of liothyronine * Data obtained via CurrentPsychiatry.com, February 2009 Note: Table made from pie chart.
Verapamil also can be combined with either lithium or divalproex
For example, both divalproex
and lamotrigine have demonstrated efficacy in treating bipolar disorder; however, divalproex
may be more effective treatment for manic episodes, whereas lamotrigine may be more effective treatment for depressive episodes and maintenance.
According to the authors, there was insufficient evidence to determine the impact of divalproex
, onabotulinumtoxinA, amitriptyline, nimodipine, or flunarizine versus placebo on headache frequency.
Recarbrio use should also be avoided for patients taking valproic acid or divalproex
A on divalproex
sodium, 250 mg 2 times a day, which is eventually titrated to 250 mg every morning with an additional daily 750 mg (total daily dose of 1,000 mg) for mood stabilization.
Studies on efficacy of divalproex
compared to lithium and placebo in acute manic episodes in children have shown mixed results [14, 15].