Valproate and lithium as maintenance therapy (1) Authors: Bowden CL, et al.; for the Divalproex Maintenance Study Group. Title: A randomised, placebo-controlled 12 month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Reference: Arch Gen Psychiatry 2000;57:481-9. Purpose: To compare the efficacy of divalproex, lithium, and placebo as prophylactic therapy of bipolar disorder. Study design: A randomized, double-blinded, parallel-group, multicenter study. Follow up: 52-week maintenance period. Patients: 372 patients (187 divalproex, 91 lithium, and 94 placebo). Treatment: Serum trough concentrations maintained as: valproate 71–125 mcg/mL and lithium 0.8–1.2 mmol/L. Results: The treatments did not differ significantly in terms of time to recurrence of any mood episode. Valproate was superior to lithium in terms of a longer duration of successful prophylaxis and less deterioration in depressive symptoms.
