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Japanese

Safety and Prophylactic Effect of Valproate Compared with Lithium in Elderly Bipolar Disorder Patients:A retrospective study Katsuji SUZUKI 1 , Teruaki TANAKA 1 , Takuya MASUI 1 , Yasuya NAKATOH 1 , Norio SHIMOTORI 1 , Miho SHINYA 1 , Tsukasa KOYAMA 1 1Department of Psychiatry, Hokkaido University Graduate School of Medicine Keyword: Valproate , Lithium , Bipolar disorder , Elderly patient pp.177-185
Published Date 2005/2/15
DOI https://doi.org/10.11477/mf.1405100012
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Summary

 It is still uncertain that valproate is more useful than lithium in the treatment for elderly patients with bipolar disorders (BD). We retrospectively investigated safety and efficacy of valproate and lithium in all the patients with BD who were currently outpatients visiting the department of psychiatry, Hokkaido University Hospital, and had started to be treated by either drug when they were 55 years old or older, comparing them with patients who sarted using either drug when they were 30 to 45 years old. Younger subjects were matched by sex to and randomly extracted so that the number of patients was the same as the number in the elderly group for each drug, N=31 (F=15, M=16) for valproate, N=49 (F=23, M=26) for lithium. The mean periods prescribed, the mean serum concentrations during the maintenance phase, and the severity of side effects did not significantly differ between the two age groups for each drug. Severe side effects were observed only in the elderly lithium-prescribed group (n=3). In 22 elderly patients, who had received both of the drugs separately, severity of side effects was significantly worse when taking lithium than valproate while the prophylactic benefit the obtained was approximately the some no matter which of the drugs were used. There was no significant difference in the prophylactic effect of valproate between the two age groups. As regards lithium, more beneficial CGI scores for prophylaxis were noticed in elderly subjects than in younger subjects in both depression and overall bipolar illness, but not in cases of mania. However, the rates of ‘very much improved’ and ‘much improved’ patients in all CGI scales for prophylaxis did not differ according to the age groups for lithium. In conclusion, although lithium might have some advantages of efficacy in use for elderly patients compared to younger patients, valproate is considered to be more useful especially in terms of safety than lithium in the treatment for elderly BD.


Copyright © 2005, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-126X 印刷版ISSN 0488-1281 医学書院

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