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Bipolar Relapse on Monotherapy Can Be Stabilized by Restarting Combination Lithium, Divalproex: Presented at AACAP

By Paula Moyer

WASHINGTON, DC -- October 25, 2004 -- Children and adolescents with bipolar disorder who have previously been stable on lithium and divalproex, and then relapse while on monotherapy, are highly likely to become stable again when the initial combination is reinstituted, according to study findings.

Robert L. Findling, MD , professor of psychiatry and pediatrics at Case Western Reserve University in Cleveland, Ohio, and is the director of child and adolescent psychiatry at University Hospitals Health System, presented his and his co-investigators' findings here October 23^rd at the 51^st annual meeting of the American Academy of Child and Adolescent Psychiatry.

"We have a growing perception that it takes more than 1 mood stabilizer to get people well, and most people need to stay on 2 after the acute phase," said Dr. Findling. However, often after the acute phase, patients' medications are adjusted so that they are only on 1 mood stabilizer. "We wanted to know whether patients who are stabilised on 2 medications and relapse while they're on 1 can be restabilized on the original combination," he said. The concern is that bipolar disorder can become less responsive to previously effective treatment with each symptomatic relapse.

The researchers recruited 38 patients into an 8-week open-label trial of lithium and divalproex in combination. The patients ranged from 5 to 17 years old and had a diagnosis of bipolar disorder I or II. The patients had previously achieved symptom remission with the study regimen and had subsequently relapsed while on monotherapy with either lithium or divalproex. In order to assess the treatment's effectiveness, the investigators used the Young Mania Rating Scale (YMRS) and the Children's Depression Rating Scale-Revised (CDRS-R).

Among these patients, 89.5% were ultimately restabilized with the investigated combination. Another 11.5% required treatment with a third medication, an atypical antipsychotic, for residual symptoms.

"We are finding that most children and adolescents with bipolar disorder need more than one medication," Dr. Findling said. "This study shows that we can tell parents not to lose hope, that if the child relapses on monotherapy, that's not a reason to be pessimistic. More can be done." At this point, researchers have not identified a way to predict which patients will require combination treatment, he said.

[Presentation title: Combination lithium and Divalproex Sodium in Pediatric Bipolar Restabilization. Abstract D25]

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