Case report Combining lithium and sodium valproate for bipolar disorder

We report two cases of severe bipolar disorder in which there was a dramatic response to the combination of lithium and sodium valproate. Both patients had failed to respond to the respective monotherapies. These cases suggest that the combination of lithium and sodium valproate may be more effective than each of these drugs used alone. There is a clear need for controlled outcome studies of the common clinical practice of combining lithium and the anticonvulsants. Australian and New Zealand Journal of Psychiatry 1994; 28:141-143 The demonstration of the effectiveness of the an-ticonvulsants in the treatment of bipolar disorder has been one of the major psychopharmacological advan-ces of the last 10 to 20 years. It is now widely accepted that carbamazepine is as effective as lithium in both the acute treatment of mania and the prophylactic management of bipolar disorder [1,2j and recent studies suggest that sodium valproate (valproate), too, has a similar therapeutic profile [3-51. In many open trials the anticonvulsants have been used in combination with lithium- a practice often also utilized in clinical practice. Despite this widespread use of combined lithium and anticonvulsants, there have been no controlled investigations of the compara-tive efficacy of the combined therapies against lithium or an anticonvulsant alone in bipolar disorder [6]