There’s been a worrying shift in the treatment of elderly patients with bipolar disorders, or manic-depression. The old standby drug lithium has been slowly replaced over the years by valproic acid.
There are two big problems about this shift. In the first place, there is absolutely no evidence to suggest that valproic acid can successfully treat bipolar disorders, as was confirmed by a recent, and exhaustive, Cochrane study. Secondly, valproic acid is better known as Epilim, designed to treat epilepsy.
Canadian researchers studied the medical records of patients registered with the Ontario Health Insurance Plan, and noted that the number of new lithium users per year fell from 653 adults in 1993 to just 281 in 2001, whereas the number of valproic acid users rose from 183 in 1993 to 1090 in 2001.
So, if there is no evidence that valproic acid can help in bipolar disorder, why is it being increasingly prescribed?
It’s a good question, but the researchers had no answers. Is the drug perhaps being oversold by zealous salesmen? It was certainly the case with a drug called Neurontin, manufactured by Warner-Lambert. The problem was highlighted recently on the NBC Dateline programme, which featured David Franklin, a former ‘medical liaison’ executive (aka salesman) for the company.
He revealed that his job was to ‘talk up’ Neurontin, so that doctors would prescribe it for diseases for which it was never intended, otherwise known as ‘off-label’, and at far higher doses than was safe.
Has the same happened with Epilim? We don’t know, but perhaps someone out there could tell us.
(Source: British Medical Journal, 2003; 326: 960-1).