Efficacy of Olanzapine in Combination With Valproate or Lithium in the Treatment of Mania in Patients Partially Nonresponsive to Valproate or Lithium Monotherapy

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Abstract
THE EXPERT Consensus Guidelines Series, published in the year 2000, recommends lithium and valproate as first-line treatments for bipolar mania.1 However, up to 40% of patients respond poorly to monotherapy with either treatment.2 When monotherapy fails, the guidelines recommend combination therapies. A number of authors have recently reviewed the use of such cotherapies for bipolar mania. Freeman and Stoll3 concluded that the combination of lithium and valproate is better tolerated and more efficacious in maintenance therapy than other combination treatments.