Kessing LV, Hellmund G, Geddes JR et al.
University Hospital of Copenhagen, Copenhagen, Denmark.
Br J Psychiatry 2011;199:57–63.
Editor’s note: Despite the somewhat sparse evidence on the effectiveness of valproate as a mood stabilizer, it is one of the most commonly used mood stabilizers worldwide, and the most commonly used mood stabilizer in the US (followed by lithium). In studies of patients with acute mania or acute depression, its efficacy has been shown to be superior to placebo. In comparator studies of valproate and lithium for the treatment of acute mania, no significant difference has been demonstrated, and no data have been published with respect to a head-to-head comparison of the two agents for treating patients with bipolar depression. Only two comparison maintenance studies have been published. In one, both lithium and valproate monotherapies showed similar efficacy to placebo at 1-year follow-up. In the other, lithium was shown to be more effective than valproate at 2-year follow-up.