BMJ  2003;327:395-396 (16 August), doi:10.1136/bmj.327.7411.395-b

Letter

Older patients are eligible for trial of lithium and valproate

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

EDITOR—Shulman et al report an increase in the prescription of valproate for elderly patients with bipolar disorder in Canada (and corresponding decrease in prescription of lithium).¹ A similar pattern has been observed in the United States over the past decade or so.² As the authors note, this change has occurred despite the limited evidence supporting the use of valproate and may indeed reflect concerns about lithium toxicity in elderly patients.

The BALANCE trial (www.psychiatry.ox.ac.uk/balance/), which is currently recruiting in the United Kingdom and soon to begin recruiting in the United States, should provide reliable evidence about the use of both lithium and valproate in bipolar disorder.³ A recent trial comparing lithium, valproate, and placebo did not find a significant difference between the treatments, probably because the inclusion of an untreated control arm meant that it was difficult to recruit patients who were judged at substantial risk . . . [Full text of this article]

jennifer.rendell@psych.ox.ac.uk

Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX

Harvard Bipolar Research Program, Massachussetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, USA on behalf of the BALANCE Investigators

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