Treatment of bipolar affective disorders with valproate. A review of the literature

This paper gives an overall review of the literature since 1980 on the use of valproate in bipolar affective disorders. Randomised comparative studies definitely demonstrate that valproate proves superior in comparison with placebo and equivalent in comparison with lithium in the treatment of acute manic episodes. A series of open studies indicates a reduction in frequency and intensity of manic and depressive episodes with the long-term administration of valproate suggesting efficaciousness in the prophylaxis of bipolar affective disorders. Details on dosage, side effects and potential interactions with this group of patients are presented. Valproate constitutes a further valuable and well tolerated alternative to lithium, antipsychotic agents and carbamazepine not only in acute therapy of manic episodes but also in prophylactic treatment of patients with bipolar psychosis.