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Preventing Bipolar Disorder Relapse: Lithium Plus Valproate Better Than Valproate Alone
Patients with bipolar disorder have a reduced risk for relapse if given a combination of lithium and valproate than if given valproate alone, according to an industry-funded study released online in Lancet.
Researchers for the international BALANCE trial randomized some 330 patients with bipolar disorder to one of three open-label regimens: lithium monotherapy, valproate monotherapy, or a combination of the two drugs. After follow-up for up to 2 years, the rate of relapse — the primary outcome — was significantly lower with combination therapy than with valproate monotherapy (54% vs. 69%). The relapse rate with lithium monotherapy (59%) did not differ significantly from that with combination therapy, but the difference compared with valproate monotherapy was of borderline significance.
The authors suggest that, contrary to guidelines that recommend valproate monotherapy as a first-line option, "patients should be advised that a better outcome would be likely" with combination therapy.
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Published in Physician's First Watch December 23, 2009
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- lithium v valproate
r ganz, 31 Dec 2009 9:10 PM EST
Wouldn't it also be fair to conclude that lithium monotherapy is as good as combo therapy?
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