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Sir: Dr. Feifel’s observational information on the effectiveness of a loading dose strategy for divalproex ER adds a pragmatic extension to our recent publication. The one caveat we would add is that dosing practices that may be well tolerated in acutely manic, hospitalized patients may be less well tolerated in less severely ill outpatients, likely consequent to lower levels of increased activation.’ ‹’ ‹

The article discussed here was supported by Abbott.‘ ‹