Effect size of lithium, divalproex sodium, and carbamazepine in children and adolescents with bipolar disorder

Roberta A. Kowatch, Trisha Suppes, Thomas J. Carmody, John P. Bucci, Judith H. Hume, Michelle Kromelis, Graham J. Emslie, Warren A. Weinberg, A. John Rush

Research output: Contribution to journalArticlepeer-review

320 Scopus citations


Objective: To develop effect sizes for 3 mood stabilizers - lithium, divalproex sodium, and carbamazepine - for the acutephase treatment of bipolar I or II disorder, mixed or manic episode, in children and adolescents aged 8 to 18 years. Method: Forty-two outpatients with a mean age of 11.4 years (20 with bipolar I disorder and 22 with bipolar II disorder) were randomly assigned to 6 weeks of open treatment with either lithium, divalproex sodium, or carbamazepine. The primary efficacy measures were the weekly Clinical Global Impression Improvement scores and the Young Mania Rating Scale (Y-MRS). Results: Using a ≥50% change from baseline to exit in the Y-MRS scores to define response, the effect size was 1.63 for divalproex sodium, 1.06 for lithium, and 1 00 for carbamazepine. Using this same response measure with the intent-to-treat sample, the response rates were as follows: sodium divalproex, 53%; lithium, 38%; and carbamazepine, 38% (χ22 = 0.85, p = 60). All 3 mood stabilizers were well tolerated, and no serious adverse effects were seen. Conclusions: Divalproex sodium, lithium, and carbamazepine an showed a large effect size in the open treatment of children and adolescents with bipolar I or II disorder in a mixed or manic episode.

Original languageEnglish (US)
Pages (from-to)713-720
Number of pages8
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number6
StatePublished - 2000


  • Bipolar disorder
  • Carbamazepine
  • Divalproex sodium
  • Effect size
  • Lithium

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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