Combination lithium and divalproex sodium in pediatric bipolar symptom re-stabilization.
OBJECTIVE
It has been reported that bipolar disorder may become less responsive to previously effective treatment with each symptomatic relapse. The primary goal of this study was to assess the rate of re-stabilization after the resumption of lithium (Li) plus divalproex (DVPX) following relapse on either agent as monotherapy.


METHODS
This is a prospective, 8-week, open-label outpatient Li/DVPX combination therapy trial. Patients ages 5 to 17 years with bipolar disorder type I or II, who had achieved symptom remission with Li/DVPX combination therapy and subsequently relapsed during treatment with Li or DVPX monotherapy were enrolled between January 1999 and January 2003.


RESULTS
Thirty-eight patients with a mean age of 10.5 years entered the study. Thirty-four (89.5%) patients responded to treatment with Li/DVPX mood stabilizer therapy alone, but four patients required adjunctive antipsychotic treatment to address residual symptomatology. Overall, reinitiation of Li/DVPX combination therapy was well tolerated with no subjects discontinuing because of a medication-related adverse event.


CONCLUSIONS
It appears that most youths with bipolar disorder who stabilize on combination Li/DVPX therapy and subsequently relapse during monotherapy can safely and effectively be re-stabilized with the reinitiation of Li/DVPX combination treatment.
Findling
Robert L
RL
From the Departments of Psychiatry (R.L.F., N.K.M., R.S., R.E.W., C.A.D., J.R.C.), Psychology (E.A.Y.), and Pediatrics (R.L.F., M.D.R.), Case Western Reserve University, University Hospitals (R.L.F., N.K.M., R.S., M.D.R., J.R.C.), Cleveland, OH; and Strong Memorial Hospital (B.L.G.), University of Rochester Medical Center, Rochester, NY. Electronic address: robert.findling@uhhs.com.
McNamara
Nora K
NK
From the Departments of Psychiatry (R.L.F., N.K.M., R.S., R.E.W., C.A.D., J.R.C.), Psychology (E.A.Y.), and Pediatrics (R.L.F., M.D.R.), Case Western Reserve University, University Hospitals (R.L.F., N.K.M., R.S., M.D.R., J.R.C.), Cleveland, OH; and Strong Memorial Hospital (B.L.G.), University of Rochester Medical Center, Rochester, NY.
Stansbrey
Robert
R
From the Departments of Psychiatry (R.L.F., N.K.M., R.S., R.E.W., C.A.D., J.R.C.), Psychology (E.A.Y.), and Pediatrics (R.L.F., M.D.R.), Case Western Reserve University, University Hospitals (R.L.F., N.K.M., R.S., M.D.R., J.R.C.), Cleveland, OH; and Strong Memorial Hospital (B.L.G.), University of Rochester Medical Center, Rochester, NY.
Gracious
Barbara L
BL
From the Departments of Psychiatry (R.L.F., N.K.M., R.S., R.E.W., C.A.D., J.R.C.), Psychology (E.A.Y.), and Pediatrics (R.L.F., M.D.R.), Case Western Reserve University, University Hospitals (R.L.F., N.K.M., R.S., M.D.R., J.R.C.), Cleveland, OH; and Strong Memorial Hospital (B.L.G.), University of Rochester Medical Center, Rochester, NY.
Whipkey
Resaca E
RE
From the Departments of Psychiatry (R.L.F., N.K.M., R.S., R.E.W., C.A.D., J.R.C.), Psychology (E.A.Y.), and Pediatrics (R.L.F., M.D.R.), Case Western Reserve University, University Hospitals (R.L.F., N.K.M., R.S., M.D.R., J.R.C.), Cleveland, OH; and Strong Memorial Hospital (B.L.G.), University of Rochester Medical Center, Rochester, NY.
Demeter
Christine A
CA
From the Departments of Psychiatry (R.L.F., N.K.M., R.S., R.E.W., C.A.D., J.R.C.), Psychology (E.A.Y.), and Pediatrics (R.L.F., M.D.R.), Case Western Reserve University, University Hospitals (R.L.F., N.K.M., R.S., M.D.R., J.R.C.), Cleveland, OH; and Strong Memorial Hospital (B.L.G.), University of Rochester Medical Center, Rochester, NY.
Reed
Michael D
MD
From the Departments of Psychiatry (R.L.F., N.K.M., R.S., R.E.W., C.A.D., J.R.C.), Psychology (E.A.Y.), and Pediatrics (R.L.F., M.D.R.), Case Western Reserve University, University Hospitals (R.L.F., N.K.M., R.S., M.D.R., J.R.C.), Cleveland, OH; and Strong Memorial Hospital (B.L.G.), University of Rochester Medical Center, Rochester, NY.
Youngstrom
Eric A
EA
From the Departments of Psychiatry (R.L.F., N.K.M., R.S., R.E.W., C.A.D., J.R.C.), Psychology (E.A.Y.), and Pediatrics (R.L.F., M.D.R.), Case Western Reserve University, University Hospitals (R.L.F., N.K.M., R.S., M.D.R., J.R.C.), Cleveland, OH; and Strong Memorial Hospital (B.L.G.), University of Rochester Medical Center, Rochester, NY.
Calabrese
Joseph R
JR
From the Departments of Psychiatry (R.L.F., N.K.M., R.S., R.E.W., C.A.D., J.R.C.), Psychology (E.A.Y.), and Pediatrics (R.L.F., M.D.R.), Case Western Reserve University, University Hospitals (R.L.F., N.K.M., R.S., M.D.R., J.R.C.), Cleveland, OH; and Strong Memorial Hospital (B.L.G.), University of Rochester Medical Center, Rochester, NY.
D000293:Adolescent; D018692:Antimanic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001714:Bipolar Disorder / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008094:Lithium / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D011446:Prospective Studies; D014635:Valproic Acid / Q000008:administration & dosage* / Q000009:adverse effects
D018692:Antimanic Agents; D014635:Valproic Acid; D008094:Lithium