Divalproex treatment of mania in elderly patients

Because lithium is difficult to use, divalproex may be an effective alternative for elderly manic patients. In this study, the authors retrospectively assessed outcome of 21 patients, age 60 to 82 years, hospitalized for a manic episode and treated with divalproex. The mean final divalproex dose was 1,405 mg/day, and the mean serum level was 72 micrograms/ml; 20 patients also received concomitant neuroleptic medication. Overall, 19 of the 21 patients (90%) were rated as Much or Very Much Improved. The only remarkable side effect, sedation, occurred in two patients and improved with dose reduction. Although the study suggests that divalproex is an effective and well tolerated treatment for elderly manic patients, the retrospective nature of the study and the concomitant administration of neuroleptic medication suggest caution in interpreting the findings.