Authors: Sun Fengli, Chen Fengpei, Zhu Jianfeng, Gao Zhihan, Shen Yin, Chen Zhenxin, Ren Zhibin, Jin Rui, Ma Yongchun, Jin Weidong.
Background: To systematically evaluate the difference in efficacy of valproate and valproate combination with lithium carbonate for therapy of bipolar mania in China. And to provide evidences for double mood stabilizer in therapy of bipolar disorder.
Methods: A meta-analysis was performed of all the literatures germane to estimate the bipolar mania patients treated with valproate combination with lithium and only valproate randomized controlled trials (RCTs) from 2007 to 2014. Odds ratios (ORs) and 95% confidence intervals (CIs) of, effective rate and remission rate were calculated and the meta-analysis was conducted with Revman5.1 software. And symptoms changes and times of relapse were also analyzed by Revman 5.1 software.
Results: A total of 5 RCTs were included. The results of meta-analysis demonstrated as following: (1). The effective rate was lower in valproate group than that of valproate combination with lithium group t(24/65vs49/65, Z=4.05, P<0.0001, OR=0.49, 95CI=0.35~0.69). (2). The remission rate was lower in valproate group than that of valproate combination with lithium group (21/100vs45/100, Z=3.62, P<0.0003,. OR=0.31, 95CI=0.17~0.59). (3). The manic scale was lower found in combination group than that in valproate group (Z=6.19, P<0.0001, WMD=2.07, 95%CI=-2.73~ -1.42). (4). The times of relapse was less found in combination group than that in valproate group, but no statistic significance (Z=1.54, P =0.10, WMD=-1.00, 95%CI=-2.37~ 0.21).
Conclusion: The results indicate that valproate combination with lithium was better than valpoate monotherapy in treatment of bipolar disorder. The double mood stabilizer concept should be enlarged for therapeutic ideas in treatment of bipolar disorder.
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