Authors: Gyulai L, et al.
Title: Maintenance efficacy of divalproex in the prevention of bipolar depression.
Reference: Neuropsychopharmacology 2003;28:1374-82.
Purpose: To compare lithium, valproate, and placebo as maintenance therapy following a manic episode and to assess patient outcome when SSRIs were used as add-on therapy to prevent depressive relapse.
Study design: Randomized, double-blinded, placebo-controlled trial.
Follow up: 1 year.
Patients: 372 outpatients with bipolar I disorder.
Treatment: Divalproex, lithium, or placebo with add-on sertraline or paroxetine (SSRI) therapy for depressive relapse.
Results: The rate of early discontinuation from the study was 45% when the SSRI was added to placebo compared with 10% when the SSRI was added to valproate. This suggests that SSRI monotherapy was inferior to combined treatment with a mood stabilizer.