When patients with classic mania and depression during mania are considered together, evidence suggests that acute treatment responses to lithium and divalproex are equivalent.1 The January 1997 issue of the ARCHIVES reported, in an important secondary analysis of the same trial, that divalproex was superior to lithium for depression during mania.2 It follows that lithium may have been superior to divalproex for classic mania in this trial. The conclusion that lithium may have been superior for classic mania is mentioned in the report's "Results" section, but deserves emphasis. The numerical magnitude of the advantage of lithium over divalproex for classic mania was similar to the magnitude of the advantage of divalproex over lithium for depression during mania. The figures from that article suggest that this conclusion holds across definitions of classic mania and across rating scales.
Woods SW. Classic Mania: Treatment Response to Divalproex or Lithium. Arch Gen Psychiatry. 1998;55(11):1050. doi: