Background: Substance abuse is a common comorbidillness in patients with mood disorders. Little has been writtenabout the pharmacologic treatment of patients with affectivelability and co-occurring substance abuse, however. The followingreport will describe clinical experience using divalproex sodiumin substance-abusing patients with mood disorder.
Method: Twenty patients admitted to anintermediate-care inpatient substance abuse program werediagnosed with comorbid mood disorder (according to DSM-IVcriteria) and treated with divalproex sodium in an open-label,naturalistic trial with no blind. All patients were followedclinically and were assessed using the Clinical GlobalImpressions scale (CGI) and laboratory studies.
Results: Seven patients referred while ondivalproex treatment continued to exhibit improved mood. Elevenothers had at least 1 week of follow-up, and 10 of these alsoshowed improvement. In 13 cases, divalproex was used safely withother psychiatric medications. Two patients complained of slighttremor, 1 of whom was also taking fluoxetine. Fifteen of 17patients in whom biochemistry and hematology laboratory studieswere completed had unremarkable results; 2 other patients hadpretreatment abnormalities, which worsened over the course oftreatment. Mean plasma valproate level was 58.53 micrograms/mL.Mean length of follow-up was 38 days. Mean period of abstinenceprior to starting medication was 48 days. Some patients reporteddecreased cravings, and, by self-report, all patients remainedabstinent.
Conclusion: This report suggests that divalproexsodium is efficacious and safe, both alone and in combinationwith other psychiatric medications, in treating substance-abusingpatients with mood disorder.
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