The effect of valproate on bipolar spectrum temperamental disorders

Cyclothymic or hyperthymic temperaments may belong to a bipolar spectrum of disorders. Patients with such temperaments, especially if there is a family history of bipolar disorder or an exacerbation of these conditions when exposed to tricyclic antidepressants, should be conceptualized as possessing variants of bipolar disorder. This conceptualization suggests that standard psychopharmacologic regimens used in treating bipolar disorder may be useful. In this report I examine the potential usefulness of valproate in treating temperamental variants of bipolar disorder.

The author reports his experience of treating patients with bipolar temperamental disorders in an Outpatient Affective Disorder Specialty Clinic. Three representative case reports are offered, as well as a discussion of the general issues in the diagnosis and treatment of these patients.

In these cases, valproate not only treated the acute symptomatology that caused these patients to seek treatment, but also led to an amelioration of noxious life-long temperamental traits. These findings strengthen other research findings that suggest a link between bipolar disorder and limbic dysfunction and add to the validation of the concept of bipolar temperamental disorders.

Valproate may be a safe and effective treatment for patients with cyclothymic and hyperthymic temperaments.