BackgroundValproate is one of the most used mood stabilisers for bipolar disorder,
although the evidence for the effectiveness of valproate is sparse.AimsTo compare the effect of valproate v. lithium for
treatment of bipolar disorder in clinical practice.MethodAn observational cohort study with linkage of nationwide registers of all
people with a diagnosis of bipolar disorder in psychiatric hospital
settings who were prescribed valproate or lithium in Denmark during a
period from 1995 to 2006.ResultsA total of 4268 participants were included among whom 719 received
valproate and 3549 received lithium subsequent to the diagnosis of
bipolar disorder. The rate of switch/add on to the opposite drug (lithium
or valproate), antidepressants, antipsychotics or anticonvulsants (other
than valproate) was increased for valproate compared with lithium (hazard
ratio (HR) = 1.86, 95% CI 1.59–2.16). The rate of psychiatric hospital
admissions was increased for valproate v. lithium (HR =
1.33, 95% CI 1.18–1.48) and regardless of the type of episode leading to
a hospital admission (depressive or manic/mixed). Similarly, for
participants with a depressive index episode (HR = 1.87, 95% CI
1.40–2.48), a manic index episode (HR = 1.24, 95% CI 1.01–1.51) and a
mixed index episode (HR = 1.44, 95% CI 1.04–2.01), the overall rate of
hospital admissions was significantly increased for valproate compared
with lithium.ConclusionsIn daily clinical practice, treatment with lithium seems in general to be
superior to treatment with valproate.
Valproate v. lithium in the treatment of
bipolar disorder in clinical practice: observational nationwide
register-based cohort study
