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Finding safe and effective treatments is a priority for child bipolar I disorder (BP-I), which has a severe and chronic natural history (JW Psychiatry Oct 27 2008). This manufacturer-supported study is the first double-blind, placebo-controlled study of extended-release divalproex in children aged 10 to 17 years with BP-I, manic or mixed phase. Divalproex (maximum dose, 35 mg/kg/day) was titrated to clinical response or to blood valproate levels (target, 80–125 µg/mL). To monitor for adverse clinical effects, researchers relied on spontaneous responses to open questions. Stable stimulant, but not atomoxetine, medications were allowed if they did not worsen mania.
Among 151 randomized participants, 74% of divalproex recipients and 82% of plac…