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Combination lithium and divalproex sodium in pediatric bipolarity
Robert L Findling1, Nora K McNamara, Barbara L Gracious
1Department of Psychiatry, Case Western Reserve University School of Medicine, USA. robert.findling@uhhs.com
Summary
Combination therapy with divalproex sodium (DVPX) and lithium (Li) effectively treated mania and depression in juvenile bipolar disorder. Many youths achieved remission, indicating this combination is a safe and effective acute treatment option.
Area of Science:
- Child and Adolescent Psychiatry
- Neuroscience
- Pharmacology
Background:
- Juvenile bipolar disorder often shows limited response to monotherapy with lithium carbonate (Li) or divalproex sodium (DVPX).
- Many young patients require alternative or combination treatment strategies for effective symptom management.
- Assessing combination therapy is crucial for improving outcomes in pediatric bipolar disorder.
Purpose of the Study:
- To evaluate the effectiveness and safety of combination divalproex sodium (DVPX) and lithium carbonate (Li) therapy in youths with bipolar disorder.
- To determine the rate of clinical remission in juvenile patients treated with DVPX + Li.
- To examine symptom changes in mania and depression using standardized rating scales.
Main Methods:
- An open-label prospective study treated 90 patients (ages 5-17) with bipolar I or II disorder for up to 20 weeks using DVPX + Li.
- Assessments included the Young Mania Rating Scale (YMRS), Children's Depression Rating Scale-Revised (CDRS-R), and Children's Global Assessment Scale (CGAS).
- Clinical remission was defined by specific weekly rating scale scores, clinical stability, and absence of mood cycling.
Main Results:
- Significant improvements (p <.0001) in YMRS, CDRS-R, and CGAS scores were observed by week 8 and sustained through study completion.
- Forty-seven percent (n=42) of patients met the predefined criteria for clinical remission.
- The combination therapy demonstrated statistically significant efficacy across all measured outcome variables.
Conclusions:
- Combination therapy with divalproex sodium (DVPX) and lithium (Li) is a safe and effective acute treatment for mania and depression in juvenile bipolar disorder.
- This treatment approach can lead to significant symptom improvement and clinical remission in a substantial portion of young patients.
- The findings support the use of DVPX + Li as a viable therapeutic option for pediatric bipolar disorder when monotherapy is insufficient.