• adolescent;
  • bipolar disorder;
  • child;
  • clinical trial;
  • divalproex sodium;
  • mania;
  • mixed;
  • mood stabilizer;
  • pediatric bipolar disorder;
  • psychopharmacology

Objective:  This prospective 6-month open trial examined the effectiveness and safety of divalproex sodium (DVPX) in pediatric mixed mania.

Method:  Thirty-four subjects with a mean age of 12.3 (SD = 3.7) years, DSM-IV diagnosis of a current mixed episode and a baseline Young Mania Rating Scale (YMRS) score >20 were treated with DVPX monotherapy. The primary outcome measures were the YMRS and the Child Depression Rating Scale-Revised. Secondary measures were the Clinical Global Impression Scale for Bipolar Disorder (CGI-BP) and the Children's Global Assessment of Functioning Scale (C-GAS). Measures of safety and tolerability were also administered.

Results:  Effect size (Cohen's d) based on change scores from baseline was 2.9 for the YMRS and 1.23 for the CDRS-R. Response rate (≥50% change from baseline YMRS score and ≤40 score on CDRS-R at the end of study) was 73.5%. The remission rate (≥50% change from baseline on YMRS, ≤40 on CDRS-R, CGI-BP-Improvement subscale of ≤2, and ≥51 CGAS score) was 52.9%. Significant improvements (p < 0.001) from baseline were seen for mean scores on all outcome measures (i.e., YMRS, CGI-BP, CDRS-R, and C-GAS). DVPX was safe and well tolerated with no serious adverse events during the 6-month trial.

Conclusion:  This study provides evidence for the effectiveness and safety of DVPX in the treatment of pediatric mixed mania over a 6-month period. Placebo-controlled, randomized trials involving larger samples will ultimately shed light on the efficacy of this agent.