Healthy Skepticism Library item: 18168

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Publication type: Journal Article

Shulman KI, Rochon P, Sykora K, Anderson G, Mamdani M, Bronskill S, Tran CT.
Changing prescription patterns for lithium and valproic acid in old age: shifting practice without evidence.
BMJ 2003 May 3; 326:(7396):960-1
http://www.bmj.com/cgi/content/full/326/7396/960?view=long&pmid=12727769

Abstract:

Over the past decade, valproic acid (prescribed as divalproex in North America) has been marketed as an alternative to lithium for treating bipolar disorders. For elderly patients, however, there is no clear evidence that valproic acid is more beneficial than lithium. Moreover, the evidence for the superiority of valproic acid in treating bipolar disordersmixed episodes and rapid cyclinghas been challenged in a recent Cochrane review.1 Valproic acid has not benefited patients with manic and psychiatric symptoms in dementia, despite the growing use of the drug in the management of these conditions.2 Recently, the relatively rapid shift in prescription patterns has been questioned.3 We describe trends in the use of lithium and valproic acid in a large population of people over 65.

Keywords:
Aged Antimanic Agents/therapeutic use* Bipolar Disorder/drug therapy* Dementia/drug therapy Humans Lithium Carbonate/therapeutic use* Physician's Practice Patterns/trends Valproic Acid/therapeutic use*