Valproate in Bipolar Disorder: Case Examples From a Family Practice

Valproate, an antiepileptic drug, is useful in the management of various nonepileptic disorders. It is an effective and generally well-tolerated medication for the treatment of bipolar disorder and has been approved by the Food and Drug Administration for use in manic states. Studies also suggest that it is effective in other bipolar spectrum illnesses. This report describes 2 clinical cases of DSM-IV bipolar disorder where valproate provided robust, sustained relief of mood symptoms. In the first case, valproate was chosen for initial therapy in a bipolar patient suffering from a mixture of hypomanic and depressive symptoms. In the second case, valproate replaced lithium in the management of a patient with an incomplete response to lithium plus an antidepressant. This report addresses relevant clinical issues and includes a brief review of the clinical pharmacology of valproate.