Its study of comparison of valproate & lithium published in BJP.

1. Dept of Psychiatry
Presentor- Dr. Nilesh Basarkar
Moderator- Dr. C Pinto , Dr. J P Rawat
Dr. Malay Dave

2. 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

3. Introduction
 Bipolar disorder – Complex heterogeneous recurrent episodic
illness.
Valproate – most commonly used mood stabilizer.

4. Aims and Objectives
To compare the effect of Valproate V. Lithium for treatment in
Bipolar disorder in clinical practice.

5. Methodology
Observational Cohort Study in Denmark
Diagnosed cases of Bipolar disorder
On Valproate or Lithium
Period – 1995 - 2006

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

7. 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

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

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

10. Risk of Psychiatric Hospital admission
n Total HR Depression Mania/Mixed
Total
Total Valproate
Valproate 719 1.33 1.32 1.29
Lithium
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

11. Cumulative incidence curves for risk of
hospital admission

12. Risk of switch to or add on of another
psychotropic
n HR
Total Valproate 290 1.86
Lithium 1555 1
Depression Valproate 50 2.52
Lithium 317 1
Manic Valproate 104 2.11
Lithium 535 1
Mixed Valproate 28 1.90
Lithium 118 1
Remission Valproate 47 1.46
Lithium 257 1

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

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

15. Take home message
Use of Lithium hampered by side effects
Renal Complications
Pregnancy
Endocrine
Neurological
Cardiovascular
Dermatological.