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Concerns about adverse effects with lithium and divalproex have led some clinicians to prefer atypical antipsychotics to these first-line treatments for late-life mania. In a multisite study, researchers randomized 244 inpatients and outpatients with bipolar I disorder (with mania, hypomania, or mixed episodes) to 9 weeks of lithium or divalproex (mean age, 68).
Despite attempts at inclusiveness, 1830 of 2403 screened patients were excluded for comorbidities (other psychoses, dementia, delirium, substance disorders, unstable or serious medical comorbidities), contraindications to lithium and divalproex, or intolerance of study drugs, including the rescue medications lorazepam or risperidone.
Antidepressants were stopped prior to the study. St…