Abstract
Sir: It has been reported by McElroy et al.1 that the onset of the antimanic effects of valproate can be accelerated by administering valproate at a loading dose of 20 mg/kg/day and that doing so produces a rapid response with minimal side effects. Since then, several studies2,3 have shown that oral-loaded dival-proex is an effective and well-tolerated treatment in patients with acute mania. However, these previous studies were limited to analysis of acute treatment effects. The tolerability of continuing the initial dose of valproate after the remission of mania has yet to be established. We conducted a naturalistic observational study to assess the safety of continuous treatment with valproate at high doses in bipolar patients.
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