ABSTRACT
This chapter concerns the comparison between atypical antipsychotics and valproate used for acute mania and for the prophylaxis of bipolar disorder. The comparison with classical antipsychotics is also considered. Discussion of antipsychotics and valproate in acute mania is topical in relation to current guidelines for the management of bipolar disorder. The revised American Psychiatric Association Guidelines1 propose a choice between lithium, valproate or an atypical antipsychotic for less severe mania. For severe mania, the Guidelines advise a combination of an antipsychotic and valproate or lithium. However, it is arguable whether as a first-line treatment a combination is better than using one or other of these drugs alone, as is recommended by the Guidelines of the British Association for Psychopharmacology.2
