Valproate in bipolar disorder: the Canadian perspective.

Lithium is the primary treatment for bipolar disorder. However, a substantial proportion of patients are either lithium-resistant or develop side-effects which limit the effectiveness of treatment. The anticonvulsants, particularly valproate and carbamazepine, are alternatives to lithium in the treatment of bipolar disorder. The data on the efficacy of these compounds are reviewed. Clinical issues relating to their use as an alternative to lithium and potentially as a first-line treatment are discussed. The role of anticonvulsants in the broad range of treatment options available for bipolar patients are evaluated.