Pharmacist asks Questions 

doctor, i am a pharmacist in new york state working on a project regarding bipolar disorder. two questions which have been raised which i'm having trouble answering are:which drug is less

likely to cause cognitive dulling,lithium or depakote? and long-term outcomes for patients with bipolar disorder are considered poor--true or false? thank you.

Dear NYPharm' -- 
1.  Lithium is generally more associated with "dulling" both in what I read and in what I see in my patients; I rarely hear about that with Depakote (sure hear about the weight gain though, as you know; by comparison, the weight thing is vastly more common than the dulling thing is with lithium; say 9/10 wt. gain on VPA versus 1/10 dulling on lithium, very roughly, in my experience -- maybe more like 1/20 for the latter, although I tend to use low doses and that might lower the rate.)

2. Outcomes are extremely varied, from no recurrence of mania after one clear episode -- i.e. "full recovery", we would have to say; to steady de! clines in overall life/mood stability, and attendant loss of function, within a few years.  The latter course is not common, but unfortunately not rare either.  I have heard Mauricio Tohen of Harvard cite a figure of 10% for that former course of no recurrence, though (although this was his specialty at the time, these estimates) that figure is hard to imagine given my experience; on the other hand, I wouldn't see those people again to know they'd recovered, now, would I?

Dr. Phelps

Published May, 2001