In a closed inpatient unit,
valproate and
lithium were initially combined in the treatment of 12 severely manic patients (ICD-10 F30, F31, F25). Onset of response and the use of additional
neuroleptic medication were analyzed. For 5 patients a comparision was performed between the index episode and a pre-treatment period during which
lithium therapy was administered without
valproate. Outcome criteria for the analysis were the latency of response and remission, as well as the dose of
neuroleptic medication necessary for additional sedation. The mean severity of
mania syndrome (
AMDP-System) in the study patients was comparable to the mean
mania score of the total manic patient population of the inpatient unit. All patients responded to the combination of
valproate and
lithium, and the mean total-remission time was 30 days for the whole group. Mean serum levels were 0.8 mmol/L for
lithium and 73.8 mg/L for
valproate. The mean remission time for the 5 readmitted patients was 22.8 days under combination treatment compared to 35.6 days in the pre-treatment episode without additional
valproate (p = 0.06). It was possible to markedly reduce the use of
neuroleptic medication in these patients from 18 601.6 mg CPZ equivalents to 3927.6 mg (p < 0.025). Initially combining
valproate and
lithium thus appears to be an effective therapeutic option for the inpatient management of severe manic syndromes.