Abstracts

Mood disorders such as irritability, depression, and anxiety are commonly reported after traumatic brain injury. Valproate is frequently used as a mood stabilizing drug.
To determine whether valproate has any effect on mood in those with traumatic brain injury Randomized, double-blind, clinical trial to compare the effects of valproate and phenytoin for seizure prophylaxis. Assessments of mood were done during valproate treatment at 1 and 6 months after injury.
Level I trauma center
189 patients on their assigned, blinded drug tested at 1 month and 145 at 6 months. Participants were at least 14 years old and had complicated mild to severe injuries.
1 week of phenytoin (followed by placebo) or 1 month or 6 months of valproate.
Brief Symptom Inventory (BSI) Despite depressive symptoms being quite common, there was no effect of valproate on depressive symptoms reported (37% [gt]1sd above on BSI depression at both 1 and 6 months, p=.84 and .44 comparing groups).
BSI hostility scale reflecting irritability indicated somewhat fewer problems overall, but again no treatment effect (about 25% [gt]1sd, p=.72 and .79).
Results on anxiety are less clear. Cross-sectionally, there was no treatment effect (p=.78 and .84), but an analysis of change from 1 to 6 months suggested a positive impact of valproate on anxiety (p=.04). Despite some elevations, there is no indication valproate decreases depression or irritability. There is a suggestion of a positive effect of long-term valproate use on anxiety. (Supported by NIH/NINDS R01 NS19643. Drug and placebo provided by Abbott Labs.)