Combination lithium and divalproex sodium in pediatric bipolarity

Robert L. Findling, Nora K. McNamara, Barbara L. Gracious, Eric A. Youngstrom, Robert J. Stansbrey, Michael D. Reed, Christine A. Demeter, Lisa A. Branicky, Kathryn E. Fisher, Joseph R. Calabrese

Research output: Contribution to journalArticlepeer-review

138 Scopus citations


Objective: Lithium carbonate (Li) or divalproex sodium (DVPX) may be effective for some juveniles with bipolar disorder. Many youths with bipolar disorder do not respond to DVPX or Li monotherapy. An open-label study was conducted to examine the effectiveness of combination DVPX and Li therapy with youths diagnosed with bipolar disorder. Method: Patients meeting DSM-IV criteria for bipolar I or bipolar II disorder, ages 5 to 17 years, were treated prospectively for up to 20 weeks with DVPX + Li. Assessments included the Young Mania Rating Scale (YMRS), Children's Depression Rating Scale-Revised (CDRS-R), and the Children's Global Assessment Scale (CGAS). The a priori definition of clinical remission utilized included four contiguous weekly ratings of YMRS ≤12.5, CDRS-R ≤40, CGAS ≥51, clinical stability, and no evidence of mood cycling. Results: Ninety patients (66 males, 24 females) were treated. Significant improvement (p < .0001) in all outcome measures was observed by week 8 as well as at the end of study. The mean time in study was 11.3 weeks. Forty-seven percent (n = 42) met a priori criteria for remission. Conclusions: Symptoms of mania and depression in juvenile bipolar disorder may be safely and effectively treated acutely with DVPX + Li.

Original languageEnglish (US)
Pages (from-to)895-901
Number of pages7
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number8
StatePublished - Aug 2003
Externally publishedYes


  • Bipolar disorder
  • Divalproex
  • Lithium

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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