From the Research
Treatment Options for Mixed State Bipolar Disorder
- Lithium and valproate are two commonly used medications for treating bipolar disorder, but their effectiveness in treating mixed state bipolar disorder varies 1, 2, 3, 4, 5.
- According to a study published in 2022, neither lithium nor valproate are suggested for the treatment of acute mixed states or bipolar depression 1.
- A 1992 study found that valproate may be particularly effective in manic patients with mixed affective states, as elevated pretreatment depression scores were associated with good response to valproate 4.
- A 2006 review of the literature suggested that valproate and olanzapine are drugs of first choice for treating acute mixed states, while lithium is not recommended due to its limited effectiveness in this context 5.
- Another study published in 2011 found that treatment with lithium seems to be superior to treatment with valproate in daily clinical practice, with a lower rate of psychiatric hospital admissions and switch/add on to other medications 3.
Comparison of Lithium and Valproate
- A 2013 study found that the continuation of aripiprazole in stabilized bipolar disorder patients treated with lithium or valproate increased the time to relapse of any mood episode for manic but not mixed patients 2.
- The same study found that both lithium and valproate groups achieved greater stability in YMRS total score with adjunctive aripiprazole, but the treatment difference was not significant for mixed episode populations 2.
- A 2022 narrative review suggested that valproate may be more effective as an antimanic rather than prophylactic agent, and may be a better choice in patients with many previous affective episodes/hospitalizations and psychiatric comorbidities 1.