Combination Treatment Better Than Single (but only just)
A two year trial comparing relapse rates from people taking either sodium valporate, or lithium plus valporate, has concluded the combination therapy reduces the likelihood of a bipolar relapse.
Results of the trial published in the medical journal The Lancet, suggests the more common practice of prescribing valporate (Depakote) alone for long-term treatment of bipolar disorder may need to be revised.
The use of a range of anticonvulsant and antipsychotic drugs have come about partly as a way of looking for alternatives to lithium carbonate which is known to have nasty side effects and requires careful monitoring. Since the 1990s, valporate has been used more and more as a long term therapy.
Professor John Geddes, from the University of Oxford, led the randomized control study by examining 330 people with bipolar across clinical centers in the USA, UK, Italy and France. During the trial 69 per cent of those taking valporate experienced a relapse, compared with 59 per cent taking lithium only, and 54 per cent taking a combination of valporate and lithium.
Compared with the valporate only condition, the results of the combination therapy are good. They seem less remarkable when compared with the lithium only condition, but clearly a modest improvement. It seems clear that there's a long way to go before any substantial improvements will be seen. Professor Geddes says, ‘we need to reinvigorate research to understand exactly what lithium does in the body and come up with new medicines that are effective, but that are easier and safer to take.' I can't imagine anyone disagreeing with these sentiments.
University of Oxford (2010, January 5) Combination therapy better than leading drug for bipolar disorder, study suggests. ScienceDaily. Retrieved February 2, 2010, from http://www.sciencedaily.com/releases/2009/12/091231165336.htm