Dept of Psychiatry

Presentor- Dr. Nilesh Basarkar Moderator- Dr. C Pinto , Dr. J P Rawat

Dr. Malay Dave

Valproate v. Lithium in the treatment of Bipolar disorder in clinical practice

The British Journal of Psychiatry 2011

Lars Vedel Kessing Gunnar Hellmund John R. Geddes Guy M. Goodwin Per Kragh Andersen

Introduction

Bipolar disorder – Complex heterogeneous recurrent episodic illness.

Valproate – most commonly used mood stabilizer.

Aims and Objectives

To compare the effect of Valproate V. Lithium for treatment in Bipolar disorder in clinical practice.

Methodology

Observational Cohort Study in DenmarkDiagnosed cases of Bipolar disorder On Valproate or LithiumPeriod – 1995 - 2006

Exclusion criteria• Anti depressants• Anti psychotics• Anti convulsants other than Valproate at the time of study

Analysis was adjusted for• Gender ( M / F )• Age group – all age in 5 year interval , upto 24years, 25-29, 30-

34, etc. upto 60-64, 65+• Purchase of Anti depressants, Anti psychotics or Anti

convulsants prior to purchase of Lithium or Valproate• Previous hospital admissions

Analysis were carried out for four sub populations• Bipolar disorder – current episode Depression Hypo manic or Manic Mixed Remission

Observation

Gender distribution and age at first purchase of Lithium and Valproate seen to be indistinguishable .

Risk of Psychiatric Hospital admission

Total Valproate

Lithium

n Total HR

Depression

Mania/Mixed

Total Valproate 719 1.33 1.32 1.29

Lithium 3549 1 1 1

Depression

Valproate 758 1.87 1.13 1.62

Lithium 106 1 1 1

Mania Valproate 1176 1.24 1.81 1.23

Lithium 274 1 1 1

Mixed Valproate 281 1.44 2.44 1.59

Lithium 82 1 1 1

Remission

Valproate 468 1.15 1.08 0.55

Lithium 78 1 1 1

Cumulative incidence curves for risk of hospital admission

Risk of switch to or add on of another psychotropic

n HRTotal Valproate 290 1.86

Lithium 1555 1Depression Valproate 50 2.52

Lithium 317 1Manic Valproate 104 2.11

Lithium 535 1

Mixed Valproate 28 1.90

Lithium 118 1

Remission Valproate 47 1.46

Lithium 257 1

Cumulative incidence curves for the risk of switch to / add on of another psychotropic

Conclusion

Overall rate of hospital admissions switch on add on to another Psychotropic was increased for Valproate .Lithium is superior to Valproate.

Take home message

Use of Lithium hampered by side effects Renal Complications Pregnancy Endocrine Neurological Cardiovascular Dermatological.