Comparison of Valproic Acid and Lithium in Mania

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Letter to the Editor

Sir: In their discussion, Frye et al. failed to account for several crucial effects that undermine the results of their study that compared valproic acid and lithium.

First, because every patient taking lithium was also taking a neuroleptic and a benzodiazepine at hospital discharge, the study population was lithium-resistant. Lithium resistance is also suggested by the long duration of illness prior to hospitalization. Simply, lithium does not work in lithium-resistant patients, and subject selection biased the results against lithium.

J Clin Psychiatry 1997;58(6):273 [letter]