Cochrane · systematic review · CD004052
Valproate for acute mania
Jochim, J, Rifkin‐Zybutz, RP, Geddes, J, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
Common Mental DisordersAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
30
current version
GRADE rated
27
No studies
3
Included studies
NR
No studies 3 · 10%Ungraded 0 · 0%Very low 10 · 33.3%Low 7 · 23.3%Moderate 5 · 16.7%High 5 · 16.7%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Valproate compared to placebo for acute mania in adults
Population: Adults (aged 18 and over) with acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Response rate at 3 weeks (primary efficacy outcome) Valproate vs placebo | OR 2.05 [1.32, 3.2] | 4 studies · 869 participants | High |
Number with any adverse event after 3 weeks (primary tolerability outcome) Valproate vs placebo | OR 1.63 [1.13, 2.36] | 3 studies · 745 participants | Moderate Downgraded: risk of bias |
Individual adverse events ‐ Sedation At 3‐8 weeks (secondary tolerability outcome) Valproate vs placebo | OR 1.76 [0.95, 3.24] | 5 studies · 932 participants | High |
Change in symptom severity at 3 weeks (secondary efficacy outcome) Valproate vs placebo | no estimate extracted | 4 studies · 907 participants | Moderate Downgraded: risk of bias, inconsistency |
Dropout rate ‐ All‐cause 3‐8 weeks (secondary acceptability outcome) Valproate vs placebo | OR 0.83 [0.64, 1.07] | 6 studies · 1156 participants | Moderate Downgraded: risk of bias |
Valproate compared to placebo for acute mania in children and adolescents
Population: Children and adolescents with acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Response rate at 4 weeks (primary efficacy outcome) Valproate vs placebo | OR 1.11 [0.51, 2.38] | 1 study · 151 participants | Very low Downgraded: risk of bias, imprecision |
Number with any adverse event at 4 weeks (primary tolerability outcome) Valproate vs placebo | OR 1.39 [0.71, 2.71] | 1 study · 150 participants | Very low Downgraded: risk of bias, imprecision |
Individual adverse events ‐ Sedation At 4 weeks (secondary tolerability outcome) Valproate vs placebo | OR 0.4 [0.12, 1.37] | 1 study · 150 participants | Very low Downgraded: risk of bias, imprecision |
Change in symptom severity at 4 weeks (secondary efficacy outcome) Valproate vs placebo | no estimate extracted | 1 study · 144 participants | Very low Downgraded: risk of bias, imprecision |
Dropout rate ‐ All‐cause At 4‐6 weeks (secondary acceptability outcome) Valproate vs placebo | OR 1.77 [0.83, 3.78] | 2 studies · 179 participants | Low Downgraded: risk of bias, imprecision |
Valproate compared to lithium for acute mania in adults
Population: Adults (aged 18 and over) with acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Response rate at 3 weeks (primary efficacy outcome) Valproate vs lithium | OR 0.8 [0.48, 1.35] | 3 studies · 356 participants | Moderate Downgraded: risk of bias |
Number of participants with any adverse event at 2‐4 weeks (primary tolerability outcome) Valproate vs lithium | OR 0.61 [0.25, 1.5] | 2 studies · 164 participants | Low Downgraded: risk of bias, imprecision |
Individual adverse events ‐ Sedation At 3 weeks (secondary tolerability outcome) Valproate vs lithium | OR 0.96 [0.35, 2.67] | 1 study · 105 participants | Low Downgraded: imprecision |
Change in symptom severity at 3 weeks (secondary efficacy outcome) Valproate vs lithium | no estimate extracted | 2 studies · 57 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Dropout rate ‐ All‐cause At 2‐4 weeks (secondary acceptability outcome) Valproate vs lithium | OR 0.83 [0.47, 1.45] | 3 studies · 388 participants | Moderate Downgraded: risk of bias |
Valproate compared to lithium for acute mania in children and adolescents
Population: Children and adolescents with acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Response rate at 8 weeks (primary efficacy outcome) Valproate vs lithium | OR 0.57 [0.31, 1.07] | 1 study · 197 participants | Very low Downgraded: risk of bias, imprecision |
Number of participants with any adverse event (primary tolerability outcome) Valproate vs lithium | no estimate extracted | NR | No studies |
Individual adverse events ‐ Sedation At 8 weeks (secondary tolerability outcome) Valproate vs lithium | OR 1.59 [0.84, 3] | 1 study · 190 participants | Very low Downgraded: risk of bias, imprecision |
Change in symptom severity of mania rating scale at 8 weeks (secondary efficacy outcome) Valproate vs lithium | no estimate extracted | 1 study · 190 participants | Very low Downgraded: risk of bias, imprecision |
Dropout rate ‐ All‐cause At 8 weeks (secondary acceptability outcome) Valproate vs lithium | OR 0.74 [0.39, 1.37] | 1 study · 197 participants | Very low Downgraded: risk of bias, imprecision |
Valproate compared to olanzapine for acute mania in adults
Population: Adults (aged 18 and over) with acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Response rate at endpoint at 3 weeks (primary efficacy outcome) Valproate vs olanzapine | OR 0.77 [0.48, 1.25] | 2 studies · 667 participants | Low Downgraded: risk of bias, inconsistency |
Number of participants with any adverse event (primary tolerability outcome) Valproate vs olanzapine | no estimate extracted | NR | No studies |
Adverse events ‐ Sedation At 3‐12 weeks (secondary tolerability outcome) Valproate vs olanzapine | OR 0.5 [0.28, 0.91] | 2 studies · 536 participants | High |
Change in symptom severity at 3 weeks (secondary efficacy outcome) Valproate vs olanzapine | no estimate extracted | 4 studies · 826 participants | High |
Dropout rate ‐ All‐cause At 3‐12 weeks (secondary acceptability outcome) Valproate vs olanzapine | OR 1.04 [0.71, 1.52] | 3 studies · 616 participants | High |
Valproate compared to risperidone for acute mania in children and adolescents
Population: Children and adolescents with acute mania
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Response rate at 8 weeks (primary efficacy outcome) Valproate vs risperidone | OR 0.16 [0.08, 0.29] | 1 study · 197 participants | Low |
Number of participants with any adverse event (primary tolerability outcome) Valproate vs risperidone | no estimate extracted | NR | No studies |
Adverse events ‐ Sedation At 8 weeks (secondary tolerability outcome) Valproate vs risperidone | OR 0.5 [0.28, 0.91] | 1 study · 189 participants | Very low Downgraded: risk of bias, imprecision |
Change in symptom severity at 5 ‐ 12 weeks (secondary efficacy outcome) Valproate vs risperidone | no estimate extracted | 2 studies · 228 participants | Low Downgraded: risk of bias, imprecision |
Dropout rate ‐ All‐cause (secondary acceptability outcome) At 5 ‐ 12 weeks Valproate vs risperidone | OR 1.96 [1, 3.82] | 2 studies · 236 participants | Low Downgraded: risk of bias, imprecision |