Differential effect of number of previous episodes of affective disorder on response to lithium or divalproex in acute mania
Swann AC, Bowden CL, Calabrese JR, Dilsaver SC, Morris DD
Department of Psychiatry and Behavioral Sciences,
University of Texas Health Science Center,
Houston 77030, USA.
Am J Psychiatry 1999 Aug; 156(8):1264-6


OBJECTIVE: The authors investigated the relationship between number of lifetime episodes of affective disorder and the antimanic response to lithium, divalproex, or placebo. METHOD: The subjects were 154 of the 179 inpatients with acute mania who entered a 3-week parallel group, double-blind study. The primary efficacy measure was the manic syndrome score from the Schedule for Affective Disorders and Schizophrenia. The relationship between improvement and number of previous episodes was investigated by using nonlinear regression analysis. RESULTS: An apparent transition in the relationship between number of previous episodes and response to antimanic medication occurred at about 10 previous episodes. For patients who had experienced more episodes, response to lithium resembled the response to placebo but was worse than response to divalproex. For patients who had experienced fewer episodes, however, the responses to lithium and divalproex did not differ and were better than the response to placebo. This differential response pattern was not related to rapid cycling or mixed states. CONCLUSIONS: A history of many previous episodes was associated with poor response to lithium or placebo but not to divalproex.
Manic Mouse
Lithium at 50
Unipolar mania
Bipolar disorders
Drugs for bipolars
Mania: medications
Lithium prophylaxis
The manic spectrum
Different types of mania
Schizoaffective disorder
The many faces of mania
Bipolar depression: undertreatment
Manic thinking, happiness and depression
Dysthymia, hyperthymia and cyclothymia
Aripiprazole (Abilify, Abilitat) for bipolar mania
Mania and emotional intensity / hyper-reactivity

and further reading

Future Opioids
BLTC Research
Utopian Surgery?
The Abolitionist Project
The Hedonistic Imperative
The Reproductive Revolution
Critique of Huxley's Brave New World

The Good Drug Guide
The Good Drug Guide

The Responsible Parent's Guide
To Healthy Mood Boosters For All The Family