New review article: The treatment of Bipolar Affective Disorder

Valproate (e.g. Orfiril® long, Episenta®) is a well established mood stabiliser with a broad spectrum of efficacy for the treatment of Bipolar Disorders (BD). The WHO lists valproate in its guidelines 'Essential Drugs and Medicines Policy' as an 'essential drug used in bipolar disorder'. Meanwhile, valproate is one of the most frequently prescribed medications for BD in the US. In numerous controlled studies valproate has demonstrated efficacy in manic syndromes equal to lithium. Valproate seems more efficacious than lithium in mixed states, psychotic mania and rapid cycling. Valproate also appears suitable as a prophylactic agent to prevent new manic or depressed episodes. Results from predominantly open studies suggest that valproate is similar efficacious in children, adolescents and adults. Valproate is also a first choice treatment for patients with BD and comorbid anxiety or substance abuse disorders. Valproate's special advantages are its rapid onset of action and its low interaction potential with other mood stabilisers, antipsychotics and antidepressants making combination therapy easier. Today, extended release formulations (ER) of valproate are preferably used resulting in more stable serum levels with once or twice per day dosing and an improved tolerability which, in turn, may impact on adherence to medication.

A literature review article evaluates in detail the positioning of valproate in mono- and combination therapy of acute mania and in the prophylaxis of Bipolar Disorders.

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