Efficacy of Divalproex vs Lithium and Placebo in Mania-Reply

Charles L. Bowden, MD
JAMA. 1994;272(13):1006. doi:10.1001/jama.1994.03520130039028.
Text Size: A A A
Published online

In Reply.  —Drs Kravitz and Fawcett point out some of the design issues that arise in clinical research on bipolar disorder. We elected to include patients without consideration of their prior treatment response. One reason for this is that for purposes of inclusion/exclusion criteria, establishing prior response to treatment is confounded by numerous factors (eg, compliance, adequacy of dosing, and recency of prior treatment) that, taken in the aggregate, weaken prior treatment response as an explicit criterion. Also, the effectiveness of divalproex compared with placebo had been demonstrated in a sample of patients who were refractory to lithium, so it was important to determine the efficacy in a more generally representative sample.1 The percentage assessed as having benefited from lithium is somewhat higher in this study than in the two other recent controlled clinical trials that reported this information; one study reported 46%2 and the other 41%3


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.