Psychiatric Quarterly, Vol. 77, No. 1, Spring 2006 (
ADJUNCT DIVALPROEX OR LITHIUM TO
CLOZAPINE IN TREATMENT-RESISTANT
Deanna L. Kelly, Pharm.D., Robert R. Conley, M.D.,
Stephanie Feldman M.S.W., Yang Yu, M.A.,
Robert P. McMahon, Ph.D., and Charles M. Richardson, M.D.
This retrospective study examined adjunct divalproex (N = 15) or lithium
(N = 9) in treatment-resistant schizophrenia patients added to clozapine and
compared to clozapine monotherapy (N = 25). Six month total BPRS scores
were similarly improved in all treatment groups, however signiﬁcantly greater
improvements occurred in the ﬁrst month for those on divalproex (-9) or lithium
(−8) vs. clozapine alone (−4.5) (F = 3.32, df = 10.43, p = 0.0003). Rates of
sedation, tachycardia, orthostasis, GI disturbances, confusion and dizziness
were similar among groups. Mean weight gain was 8.7 pounds for clozapine
monotherapy, 3.0 pounds in the adjunct divalproex group and 13.3 pounds
in the adjunct lithium group (P = NS). A trend was noted for greater in-
creases in blood glucose levels for those treated with adjunct lithium (F = 2.62,
df = 2.28, p = 0.09). The addition of divalproex was signiﬁcantly more effective
in reducing global symptoms (driven by hostility and anxiety) in the ﬁrst month
All authors are afﬁliated with Maryland Psychiatric Research Center, University of
Maryland, Box 21247, Baltimore, MD 21228.
Address correspondence to Deanna L. Kelly, Pharm.D., Maryland Psychiatric Research
Center, Box 21247, Baltimore, MD 21228; e-mail: firstname.lastname@example.org.
2006 Springer Science+Business Media, Inc.