Divalproex Sodium in Substance Abusers With Mood Disorder.
J Clin Psychiatry 2000;61(12):916-921
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Substance abuse is a common comorbid
illness in patients with mood disorders. Little has been written
about the pharmacologic treatment of patients with affective
lability and co-occurring substance abuse, however. The following
report will describe clinical experience using divalproex sodium
in substance-abusing patients with mood disorder.
Method: Twenty patients admitted to an
intermediate-care inpatient substance abuse program were
diagnosed with comorbid mood disorder (according to DSM-IV
criteria) and treated with divalproex sodium in an open-label,
naturalistic trial with no blind. All patients were followed
clinically and were assessed using the Clinical Global
Impressions scale (CGI) and laboratory studies.
Results: Seven patients referred while on
divalproex treatment continued to exhibit improved mood. Eleven
others had at least 1 week of follow-up, and 10 of these also
showed improvement. In 13 cases, divalproex was used safely with
other psychiatric medications. Two patients complained of slight
tremor, 1 of whom was also taking fluoxetine. Fifteen of 17
patients in whom biochemistry and hematology laboratory studies
were completed had unremarkable results; 2 other patients had
pretreatment abnormalities, which worsened over the course of
treatment. Mean plasma valproate level was 58.53 micrograms/mL.
Mean length of follow-up was 38 days. Mean period of abstinence
prior to starting medication was 48 days. Some patients reported
decreased cravings, and, by self-report, all patients remained
Conclusion: This report suggests that divalproex
sodium is efficacious and safe, both alone and in combination
with other psychiatric medications, in treating substance-abusing
patients with mood disorder.