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Cited by 105Bipolar Disorder and TreatmentSchizophrenia research and treatmentTreatment of Major Depression

Valproate v.lithium in the treatment of bipolar disorder in clinical practice: observational nationwide register-based cohort study

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Kessing, Lars Vedel, Hellmund, Gunnar, Geddes, John R., Goodwin, Guy M., Andersen, Per Kragh·2011·British Journal of Psychiatry
DOI 10.1192/bjp.bp.110.084822
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Abstract

Background: Valproate is one of the most used mood stabilisers for bipolar disorder, although the evidence for the effectiveness of valproate is sparse. Aims: To compare the effect of valproate v.lithium for treatment of bipolar disorder in clinical practice. Method: 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. Results: 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 (HR = 1.87, 95% CI 1.40–2.48), a manic index episode (HR = 1.24, 95% CI 1.01–1.51) and a mixed index episode (HR = 1.44, 95% CI 1.04–2.01), the overall rate of hospital admissions was significantly increased for valproate compared with lithium. Conclusions: In daily clinical practice, treatment with lithium seems in general to be superior to treatment with valproate.

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Authors
Kessing, L. V., Hellmund, G., Geddes, J. R., Goodwin, G. M., & Andersen, P. K.
Affiliations
  • Copenhagen University Hospital (DK)
  • University of Copenhagen (DK)
  • Warneford Hospital (GB)
Corresponding author
Kessing, Lars Vedel
ORCID
Venue
British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2011-07
Volume
199
Issue
1
Pages
57-63
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.bp.110.084822
OpenAlex
W2121552371
Cited by
105
References
38
Citations by year
2026: 1 · 2025: 3 · 2024: 6 · 2023: 2 · 2022: 3 · 2021: 7 · 2020: 5 · 2019: 10 · 2018: 7 · 2017: 14 · 2016: 5 · 2015: 5 · 2014: 11 · 2013: 14 · 2012: 7
FWCI
8.10
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified, 2377 d)
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
Funders
  • Bristol-Myers Squibb
  • Eli Lilly and Company
  • AstraZeneca
  • GlaxoSmithKline
  • Sanofi
  • Stanley Medical Research Institute
  • National Institute for Health and Care Research
  • University of Oxford
  • Eisai
  • Servier
  • H. Lundbeck A/S (P1vital)
  • Medical Research Council
  • Economic and Social Research Council
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
bipolar disorder, valproic acid, lithium, mood stabilizers, psychiatric hospital admissions, depressive episodes, manic episodes, mixed states, antidepressant use, antipsychotic use, anticonvulsant use, drug switching, treatment effectiveness
MeSH terms
Adult, Aged, Bipolar Disorder, Denmark, Epidemiologic Methods, Female, Hospitalization, Hospitals, Psychiatric, Humans, Male, Middle Aged, Antipsychotic Agents, Valproic Acid, Outcome Assessment, Health Care, Lithium Compounds, Antimanic Agents, Young Adult, Drug Substitution

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