Valproate for the treatment of acute bipolar depression: systematic review and meta-analysis

Abstract

Background: Our aim was to analyse existing data on the efficacy and tolerability of valproatefor the treatment of acute bipolar depression.Methods: Randomized controlled trials comparing valproate with placebo were identified usingsearches of electronic databases in October 2008. Outcomes investigated were depression,anxiety, hypomania, attrition, and adverse events. Trial quality was assessed, and data weresummarized using meta-analyses.Results: Four randomized, controlled, doubleblind trials of 142 participants were included. Trialquality was good, although individual study sample sizes were small. Study duration was sixweeks (2 studies) and eight weeks (2 studies). Meta-analysis showed a significant difference infavour of valproate for reduction in depressive symptoms, both on depression symptom scales(standardized mean difference (SMD) ?0.35 (95% confidence interval, ?0.69, ?0.02)), andparticipants with at least 50% improvement in symptoms β€” relative risk (RR) 2.00 (1.13, 3.53).Effects on anxiety symptoms were small,SMD?0.32 (?0.72, 0.08) and inconclusive (p=0.12).No evidence of a difference in mania symptoms, withdrawal for any reason, lack of effectivenessor adverse events was detected. Nausea occurred more frequently with valproate comparedwith placebo though the difference was not significant, RR 2.01 (0.98, 4.11). Other adverseevents occurring more frequently with valproate (somnolence, fatigue/muscle weakness,headache, diarrhoea and dry mouth) did not differ significantly between treatment groups.Limitations: Sample sizes were small warranting a larger study to confirm or disprove thesefindings.Conclusions: Valproate is effective for the reduction of depressive symptoms of acute bipolardepression, and was well tolerated

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Southampton (e-Prints Soton)

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Last time updated on 02/07/2012

This paper was published in Southampton (e-Prints Soton).

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