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

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7396.960 (Published 03 May 2003) Cite this as: BMJ 2003;326:960
  1. Kenneth I Shulman ([email protected]), professora,
  2. Paula Rochon, assistant directorc,
  3. Kathy Sykora, biostatisticianb,
  4. Geoffrey Anderson, senior adjunct scientistb,
  5. Muhammad Mamdani, scientistb,
  6. Susan Bronskill, scientistb,
  7. Chau T T Tran, doctoral candidateb
  1. a Department of Psychiatry, Sunnybrook and Women's College Health Sciences Centre, Faculty of Medicine, University of Toronto, Toronto, ON, Canada M4N 3M5
  2. b Institute for Clinical Evaluative Sciences (ICES), Sunnybrook and Women's College Health Sciences Centre
  3. c Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, Toronto, ON, Canada M6S 2E1
  1. Correspondence to: K I Shulman
  • Accepted 13 January 2003

Over the past decade, valproic acid (prescribed as divalproex in North America) has been marketed as an alternative to lithium for treating bipolar disorders. For elderly patients, however, there is no clear evidence that valproic acid is more beneficial than lithium. Moreover, the evidence for the superiority of valproic acid in treating bipolar disorders—mixed episodes and rapid cycling—has been challenged in a recent Cochrane review.1 Valproic acid has not benefited patients with manic and psychiatric symptoms in dementia, despite the growing use of the drug in the management of these conditions.2 Recently, the relatively rapid shift in prescription patterns has been questioned.3 We describe trends in the use of lithium and valproic acid in a large population of people over 65.

Methods and results

We obtained information on drug use from the Ontario Drug Benefit Program, which provides comprehensive drug benefits to all residents aged 65 or older in Ontario, Canada. …

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