Low-Dose Lithium Augmentation of Divalproex in Geriatric Mania

Letter to the Editor

Sir: It is widely believed that antimanic efficacy with lithiumrequires doses at a level sufficient to achieve blood levels > 0.7mEq/L, although few data exist about bipolar patients who mayrespond to doses producing lower serum levels. In addition, asanticonvulsant mood stabilizers enter wider use, little is knownabout whether some bipolar patients respond preferentially tolithium or to combinations of lithium and anticonvulsants. Wereport 2 cases of geriatric mania that occurred after lithium discontinuationdue to neurotoxicity.