VALPROATE AS A LOADING TREATMENT IN ACUTE MANIA

Evidence from earlier studies indicates that the antimanic action of v alproate becomes most apparent within 1-4 days of achieving serum conc entrations 50 mug/ml, that valproate can be orally loaded with achieve ment of therapeutic serum concentrations within the first several days of treatment, there is a rapid onset of response, and minimal side ef fects. To provide further data on the safety and efficacy of valproate oral loading in the treatment of acute mania, we evaluated 13 consecu tive patients with acute manic syndromes who received valproate initia ted at a dosage of 20 mg/kg/day. In most cases, valproate was added to other psychotropics. All 13 patients received at least 5 full days of valproate maintained at or above 20 mg/kg/day, and valproate serum co ncentrations were 50 mug/ml (mean +/- SD = 88 + 25) by the second or t hird day of treatment. Ten (77%) patients displayed a moderate or mark ed response. Side effects were infrequent and minor. Consistent with o ur earlier study, these findings suggest that valproate can be safely administered via a loading dose of 20 mg/kg/day to patients with acute mania, including those on other psychotropics, and that it may produc e a rapid response with minimal side effects.