Lithium, Divalproex Efficacy Examined in Older Bipolar Patients

A total of 224 inpatients and outpatients aged ≥60 with bipolar I disorder were enrolled in the study
A total of 224 inpatients and outpatients aged ≥60 with bipolar I disorder were enrolled in the study

Findings from the first study (Geri-BD) to investigate treatment efficacy in late-life mania have been published in The American Journal of Psychiatry.

As older patients may be more susceptible to the side effects of mood stabilizing drugs, the study sought to provide clinicians with information on the effectiveness of lithium and divalproex in this patient population. “In general, treatment adequacy may be limited by side effects, and you can't benefit from a treatment unless you can tolerate it,” said lead author Robert C. Young, M.D., Weill Cornell Medicine and New York Presbyterian Hospital.

A total of 224 inpatients and outpatients aged ≥60 with bipolar I disorder who presented with manic, hypomanic, or mixed episodes were enrolled. They were randomized to either lithium (target serum concentration, 0.80–0.99 mEq/L) or divalproex (target serum valproate concentration, 80–99 μg/mL) for 9 weeks.  

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Results demonstrated that lithium was more effective in controlling manic signs and symptoms, as defined by a change from baseline Young Mania Rating Scale (change in score, 3.90; 97.5% CI=1.71, 6.09). Each treatment group had a similar proportion of patients reach target concentration (57% in the lithium group vs. 56% in the divalproex group). Response rates at week 9 were also similar: 79% (lithium) and 73% (divalproex). Rates of remission were 69.6% (lithium) and 63.4% (divalproex). While the doses and blood level targets were lower in this study, the rates of response and remission were found to be similar to outcomes seen in younger patients. The groups did not differ significantly in ratings of sedation, however lithium patients were more likely to report experiencing tremor. 

The authors concluded that the findings were reassuring for both lithium and divalproex in this patient population.  

For more information visit Psychiatryonline.org.