title: Combination lithium and divalproex sodium in pediatric bipolarity.
abstract: OBJECTIVE
  Lithium carbonate (Li) or divalproex sodium (DVPX) may be effective for some juveniles with bipolar disorder. Many youths with bipolar disorder do not respond to DVPX or Li monotherapy. An open-label study was conducted to examine the effectiveness of combination DVPX and Li therapy with youths diagnosed with bipolar disorder.
  
  
  METHODS
  Patients meeting DSM-IV criteria for bipolar I or bipolar II disorder, ages 5 to 17 years, were treated prospectively for up to 20 weeks with DVPX + Li. Assessments included the Young Mania Rating Scale (YMRS), Children's Depression Rating Scale-Revised (CDRS-R), and the Children's Global Assessment Scale (CGAS). The a priori definition of clinical remission utilized included four contiguous weekly ratings of YMRS </=12.5, CDRS-R </=40, CGAS >/=51, clinical stability, and no evidence of mood cycling.
  
  
  RESULTS
  Ninety patients (66 males, 24 females) were treated. Significant improvement (p <.0001) in all outcome measures was observed by week 8 as well as at the end of study. The mean time in study was 11.3 weeks. Forty-seven percent (n = 42) met a priori criteria for remission.
  
  
  CONCLUSIONS
  Symptoms of mania and depression in juvenile bipolar disorder may be safely and effectively treated acutely with DVPX + Li.
authors.affiliation: Department of Psychiatry, Case Western Reserve University School of Medicine, USA. robert.findling@uhhs.com
authors.forename: Robert L
authors.initials: RL
authors.lastname: Findling
authors.forename: Nora K
authors.initials: NK
authors.lastname: McNamara
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Gracious
authors.forename: Eric A
authors.initials: EA
authors.lastname: Youngstrom
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stansbrey
authors.forename: Michael D
authors.initials: MD
authors.lastname: Reed
authors.forename: Christine A
authors.initials: CA
authors.lastname: Demeter
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Branicky
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Fisher
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
mesh_terms: D018692:Antimanic Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D014635:Valproic Acid / Q000627:therapeutic use*
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D016651:Lithium Carbonate; D014635:Valproic Acid