Adjunct extended-release valproate semisodium in late life schizophrenia

OBJECTIVE: Adjunctive anticonvulsant medications may benefit some individuals with schizophrenia, however data on adjunct anticonvulsants in older adults with schizophrenia is limited. This prospective, 12-week open label study evaluated adjunct extended-release valproate semisodium (divalproex) in 20 older adults with schizophrenia. METHODS: The study was conducted at an academic psychiatry clinic in the mid-western United States. Participants were self-referred from posted advertisements or referred by clinic practitioners. Extended-release valproate semisodium was added onto antipsychotic treatment. Individuals with active substance use disorders or active significant medical comorbidity were excluded. Primary outcome measures included the Positive and Negative Syndrome Scale (PANSS), Geriatric Depression Scale (GDS) and Global Assessment Scale (GAS). Tolerability was evaluated via patient self-reported side effects, change from baseline in body weight and change on abnormal movement scales. RESULTS: Patients (mean age 61 years, range 49.8-79.2 years) had significant reductions in psychosis scores as measured by the Positive and Negative Syndrome Scale (PANSS) p<0.01, as well as in global functioning as measured by the Global Assessment Scale (GAS) p<0.01 and depression as measured by the Geriatric Depression Scale (GDS) p<0.05. Mean dose of extended-release valproate semisodium was 587.50 mg/day SD+/-247.02. Extended-release valproate semisodium was well tolerated in this older adult population. The primary adverse effect was sedation, which appeared to be relatively dose and titration-speed dependent. Weight change was not significant. CONCLUSION: While extended-release valproate semisodium appears efficacious and well tolerated in older adults with schizophrenia, data from larger, controlled trials is needed.