Valproate v. lithium in the treatment of bipolar disorder in clinical practice: observational nationwide register-based cohort study Full Text
The British Journal of Psychiatry, 07/27/2011
Kessing LV et al. – In daily clinical practice, treatment with lithium seems in general to be superior to treatment with valproate.Methods
- An observational cohort study with linkage of nationwide registers of all people with a diagnosis of bipolar disorder in psychiatric hospital settings who were prescribed valproate or lithium in Denmark during a period from 1995 to 2006.
- A total of 4268 participants were included among whom 719 received valproate and 3549 received lithium subsequent to the diagnosis of bipolar disorder.
- The rate of switch/add on to the opposite drug (lithium or valproate), antidepressants, antipsychotics or anticonvulsants (other than valproate) was increased for valproate compared with lithium (hazard ratio (HR) = 1.86, 95% CI 1.59–2.16).
- The rate of psychiatric hospital admissions was increased for valproate v. lithium (HR = 1.33, 95% CI 1.18–1.48) and regardless of the type of episode leading to a hospital admission (depressive or manic/mixed).
- Similarly, for participants with a depressive index episode, a manic index episode and a mixed index episode, the overall rate of hospital admissions was significantly increased for valproate compared with lithium.