Changing prescription patterns for lithium and valproic acid in old age: shifting practice without evidence

doi:10.1136/bmj.326.7396.960

BMJ 2003;326:960-961 ( 3 May )

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Changing prescription patterns for lithium and valproic acid in old age: shifting practice without evidence

Kenneth I Shulman, professor ^a, Paula Rochon, assistant director ^c, Kathy Sykora, biostatistician ^b, Geoffrey Anderson, senior adjunct scientist ^b, Muhammad Mamdani, scientist ^b, Susan Bronskill, scientist ^b, Chau T T Tran, doctoral candidate ^b.

^a Department of Psychiatry, Sunnybrook and Women's College Health Sciences Centre, Faculty of Medicine, University of Toronto, Toronto, ON, Canada M4N 3M5, ^b Institute for Clinical Evaluative Sciences (ICES), Sunnybrook and Women's College Health Sciences Centre, ^c Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, Toronto, ON, Canada M6S 2E1

Correspondence to: K I Shulman ken.shulman@sw.ca

The first 150 words of the full text of this article appear below.

Over the past decade, valproic acid (prescribed as divalproex in North America) has been marketed as an alternative to lithiumfor treating bipolar disorders. For elderly patients, however,there is no clear evidence that valproic acid is more beneficialthan lithium. Moreover, the evidence for the superiority of valproicacid in treating bipolar disorders $---$ mixed episodes and rapid cycling $---$ hasbeen challenged in a recent Cochrane review.¹ Valproic acidhas not benefited patients with manic and psychiatric symptomsin dementia, despite the growing use of the drug in the managementof these conditions.² Recently, the relatively rapid shiftin prescription patterns has been questioned.³ We describetrends in the use of lithium and valproic acid in a large populationof people over65.

Methods and results

We obtained information on drug use from the Ontario Drug Benefit Program, which provides comprehensive drug benefits to allresidents aged 65 or older in Ontario, Canada. We . . . [Full text of this article]

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