We appreciate Dr Woods' well-taken question on differences between responses to lithium and divalproex. As he points out, there was a consistent tendency for response to lithium to be quite robust in classic mania but unsatisfactory in depressive mania. Response to divalproex seemed to be intermediate between those extremes for either classic or depressive mania. This was the case regardless of the definition of depressive mania. In response to his question, we carried out a post hoc analysis comparing change during lithium or divalproex treatment in classic and depressive mania. Table 1 summarizes the case for change in scores on the Mania Rating Scale, using the Schedule for Affective Disorders and Schizophrenia depressed mood criterion, which was the most stringent criterion used and which most closely resembles standard clinical definitions of mixed states.1
Swann AC, Bowden CL, Morris DD. Classic Mania: Treatment Response to Divalproex or Lithium—Reply. Arch Gen Psychiatry. 1998;55(11):1050. doi:
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