Acute manic excitement is disturbing for patients, their relatives and society. Rapid resolution of acute manic episodes can reduce the substantial personal and economic burden on patients, their relatives and society.
Treatment of bipolar disorder includes anticonvulsants and antipsychotics.1–5
Conventional neuroleptics such as haloperidol and chlorpromazine and novel antipsychotics such as risperidone, olanzapine and ziprasidon are effective in treating acute mania.1,4,6
The efficacy of neuroleptics in treating manic symptoms is related to their D2
receptor blockade, while the efficacy of mood stabilizers is related to their own specific mechanism such as blockage of synthesis of IP3
with lithium, and that of the GABAergic system with sodium valproate.4,5,7,8
In the USA, the anticonvulsant divalproex sodium is widely used because of its proven antimanic activity and evidence of long-term protective effect against recurrence of bipolar disorder. Its effects are dependent on the dose and serum concentration.2,4,8
. To exert an antimanic effect, the plasma therapeutic level should be in the range of 45–150 mg/L.9
It has been claimed that rapid resolution of manic symptoms can be achieved with a loading dose of 20 mg/kg/day, which starts after 5 days of therapy.10
Due to gastrointestinal intolerance and poor compliance in some of the acutely ill patients it was not possible to administer an oral loading dose, hence the injectable route was used.10–12
This study proposed to test the efficacy of injectable sodium valproate as compared with oral sodium valproate.