Abstract
Twenty-six patients with refractory affective disorders who were taking valproate after failing on standard psycho-pharmacological regimens were followed in an open-label fashion for an average of 4 years. Valproate, frequently in combination with lithium, carbamazepine, or other previously partially effective medications, reduced the number and severity of affective episodes over the study period. The results indicate that valporate shares with lithium and carbamazepine a tendency towards overall mitigation of the frequency and amplitude of affective cycles. Psycho-pharmacological combinational strategies were employed in a majority of the patients. Overall improvement in illness index and global assessment scales over the study period supports the use of systematic medication trials, and the model of an “emotion regulation circuit” conceptualized psychopharmacologically.