Open Trial of Valproate in the Treatment of Adolescent Mania

Abstract

Eleven adolescent patients with bipolar disorder (ages 12 to 17 years) hospitalized for acute mania were treated prospectively with open-label valproate after failing to respond to lithium and/or antipsychotics. Valproate doses ranged from 500 to 2000 mg/day, serum concentrations ranged from 38 to 94 μg/ml, and durations of inpatient valproate treatment ranged from six to 26 days. All 11 patients received concurrent antipsychotic medication, and five patients received concomitant lithium. Nine of the 11 patients had at least a moderate therapeutic response when valproate was added to their medication regimen. The only side effect was sedation, occurring in two patients. These preliminary data suggest that valproate may be an effective and well-tolerated treatment for acute mania in adolescents with bipolar disorder. Although valproate appears to have a generally favorable record of safety based on its long-term use in treating children and adolescents with seizure disorders, clinicians are advised to exercise caution until double-blind, placebo-controlled studies demonstrate safety and efficacy in adolescents with mania.