DYSPHORIC MANIA

Lithium remains the mainstay of therapy for most patients with bipolar disorder. Patients with syndromal variations of bipolar disorder, such as those experiencing mixed states or dysphoria have generally had a rather poor therapeutic response to lithium. Our group conducted a double-blind, parallel-group comparison of lithium and valproate for the control of mania in 27 patients with bipolar disorder. The study addressed the question of whether certain illness characteristics might be predictive of a positive response to a particular pharmacologic agent. There were significant differences in the cohort of patients who responded favorably to valproate compared with those who did not. Pretreatment depression scores were higher in the patients responding to valproate than in nonresponders. Patients with depressed mood or anxiety associated with mixed states responded equally to lithium and valproate. Studies are needed to clarify the clinical and pathophysiologic status of mixed or dysphoric manic states and to validate predictors of response to therapeutic agents.