EFFICACY OF DIVALPROEX SODIUM IN PATIENTS WITH PANIC DISORDER AND MOOD INSTABILITY WHO HAVE NOT RESPONDED TO CONVENTIONAL THERAPY

Objective: To determine the efficacy of divalproex sodium in the treat ment of psychiatric outpatients with treatment refractory panic disord er and comorbid mood instability. Method: This was an 8-week, open-tri al, flexible-dose outcome study conducted at a tertiary care referral centre. Individuals with panic disorder who failed to respond to a cog nitive behavioural treatment program and standard antipanic medication , who also suffered from mood instability, were chosen to participate in the study. Divalproex sodium was administered at a flexible dose to reach serum levels of 300 to 600 mu mol/L (45 to 90 mu g/ml) unless l imited by tolerance. Patients were rated by self-and rater-administere d questionnaires that measured the number of panic attacks, the degree of agoraphobic avoidance the levels of depression, anxiety, and mood swings, and the perceived sense of well being. Results: Thirteen subje cts were enrolled in the study, and 10 subjects completed it. Two drop ped out early because of the medication side effects, and I was lost w ithin the first month of follow-up. All 10 subjects showed significant improvement in depressive and anxiety symptoms and mood instability. There was also a statistically and clinically significant improvement in panic attacks and measures of quality of life. Conclusions: These f indings suggest that divalproex sodium is useful in the treatment of p atients with panic disorder and concomitant mood instability, who are refractory to conventional treatment. Double-blind trials will be requ ired to verify these findings.