About one-third of patients receiving long-term treatment of valproate or lithium for bipolar disorder had good treatment responses, according to data published in the International Journal of Bipolar Disorders. Additionally, mixed and psychotic features and comorbid anxiety disorder were associated with poor treatment response.

Sung Woo Ahn, Department of Psychiatry at Sunkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea, and colleagues sought to determine the long-term clinical response of mood stabilizer treatment in 80 patients with bipolar I disorder or bipolar II disorder taking lithium or valproate for more than 2 years.

The researchers used the Alda scale to measure the long-term response to the treatments and evaluated clinical characteristics on a lifetime basis. The participants were classified as good responders or as moderate/poor responders based on frequentist mixture analysis using the total Alda scale score.

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The results showed that 34% of the patients were good responders, with a total Alda score of 5 or higher. Treatment responses did not differ between the lithium and valproate groups, but lithium and valproate combination treatment was linked to worse responses.

The investigators also examined baseline characteristics to identify clinical factors associated with long-term mood stabilizer treatment, including disease onset and course, symptoms of episodes, and comorbidities. They found that co-morbid anxiety disorders were more frequently observed in the moderate/poor response group.

“Worse treatment response in patients with more previous mixed episodes, delusions during manic episodes, and appetite increase during depressive episodes was observed not only in the main analysis of all subjects but also in the supplementary analysis of [bipolar I disorder] patients alone,” they add.


  1. Ahn SW, Baek JH, Yang SY, et al. Long-term response to mood stabilizer treatment and its clinical correlates in patients with bipolar disorders: a retrospective observational study. Int J Bipolar Disord. 2017;5(24). doi:10.1186/s40345-017-0093-5