What is valproate treatment for bipolar disorder?

Valproate and its derivitive, divalproex, are anticonvulsants used primarily in the treatment of epilepsy and migraine headaches. Anticonvulsant medications influence the actions of neurotransmitters leading to a decrease in brain cell (neuron) excitability. In bipolar disorder, valproate is used mainly for the treatment of mania or mixed symptoms.

What is the evidence for valproate as a treatment for bipolar disorder?

Compared to placebo, moderate to high quality evidence found a medium-sized improvement in acute mania symptoms with valproate, and moderate to low quality evidence found a medium-sized improvement in acute depression symptoms. There was a medium-sized effect of fewer relapses over 12 months with valproate. Moderate quality evidence also found valproate + lithium may also be effective for preventing relapses, particularly to mania.

Compared to imipramine, moderate quality evidence found fewer relapses with valproate + lithium or valproate + aripiprazole. There were fewer relapses with valproate + aripiprazole than with paliperidone.

For side effects, moderate quality evidence found lamotrigine and placebo were better tolerated than valproate + lithium. Valproate can result in higher rates of polycystic ovary syndrome, hyperandrogenism, and menstrual disorders than other medications.

Also see the topic on relapse prevention.

November 2021

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Last updated at: 1:25 pm, 15th February 2022
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