Valproate use in acute mania and bipolar disorder: an international perspective

The author reviews European studies on the effect of the anticonvulsant agent valproate in the treatment of bipolar affective disorder. Since mania is associated with depletion of inhibitory transmitters in the central nervous system and gamma-aminobutyric acid (GABA) is one of the most important inhibitory transmitters, the GABAergic effects of valproate provide a theoretical basis for its use in affective disorders. The European studies, which have been both open and controlled, showed beneficial effects of valproate in acute and prophylactic treatment of bipolar illness, with particularly good results in mania. Side effects reported most often were mild and transient, and included gastrointestinal upset, lethargy, increased levels of hepatic transaminases, and mild alopecia.