Long-Term Outcome with Divalproex in Children and Adolescents with Bipolar Disorder

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Abstract
To assess the outcome and safety of divalproex treatment in children and adolescents with bipolar disorder. We conducted a chart review of children and adolescents who were treated with divalproex and who met Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria for bipolar disorder (dose 966 +/- 501 mg/day, level 79.4 +/- 23.1 micro g/mL, duration 1.4 +/- 1.5 years). Responders were defined as those showing moderate to marked response on the Clinical Global Impression-Improvement (CGI-I) scale. Eight of 15 (53%) patients responded to divalproex treatment for mixed episode (n = 6), disruptive behavior (n = 4), pure mania (n = 3), or depression (n = 2). Six of 15 (40%) discontinued divalproex, most due to side effects (n = 5). The most common side effect was weight gain (4/15, 27%). In children aged 4-18 years, divalproex treatment was related to improved outcome in the long-term treatment of bipolar disorder. One third of the patients discontinued treatment secondary to side effects, including a case of reversible liver enzyme elevation.