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Prescribing patterns of lithium or lithium+valproate in manic or mixed episodes: a naturalistic study

Muti, Matteoa; Del Grande, Claudiab; Musetti, Laurab; Marazziti, Donatellab; Pergentini, Ireneb; Corsi, Martinab; Turri, Miloa; Umberto Corsini, Giovannia; Dell’Osso, Lilianab

International Clinical Psychopharmacology: November 2013 - Volume 28 - Issue 6 - p 305–311
doi: 10.1097/YIC.0b013e3283642348
Original Articles

The present study aimed to identify the prescribing patterns of lithium or of lithium+valproate in 75 bipolar I outpatients in a manic or a mixed phase within a naturalistic setting. The differences between the two treatments and the correlation between serum lithium levels and response were also examined. The results showed that patients with lithium levels of 0.60 mEq/l or more had higher remission rates and greater symptom reduction than the other patients. Patients on lithium and valproate showed greater improvement in mixed, anxiety, and psychotic symptoms than those on lithium only, as assessed by the Clinical Global Impression-Bipolar version scale scores. Finally, our findings suggest that a range of lithium levels between 0.40 and 0.60 mEq/l, albeit below the therapeutic range, seems sufficient to maintain a good effect when lithium is coadministered with valproate.

Departments of aTranslational Research and New Technologies in Medicine and Surgery

bClinical and Experimental Medicine, University of Pisa, Pisa, Italy

Correspondence to Laura Musetti, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy Tel: +39 050 2219768; fax: +39 050 2219787; e-mail:

Received April 9, 2013

Accepted June 11, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins