Sodium Valproate for Emotional Lability

Evidence for Valproate Use in Mood Disorders

• Valproate is primarily indicated and FDA-approved for the treatment of acute mania in bipolar disorder in adults, not specifically for emotional lability, as recommended by the American Academy of Child and Adolescent Psychiatry 1, 2
• In bipolar disorder, valproate is considered a standard therapy along with lithium and atypical antipsychotics for managing mood instability, with a strength of evidence supported by the American Academy of Child and Adolescent Psychiatry 2, 3

Considerations for Specific Populations

Patients with Intellectual Disability and Epilepsy

• Valproate may be considered for patients with intellectual disability and epilepsy who may also experience emotional lability, as it has a lower risk of behavioral adverse effects compared to phenytoin or phenobarbital, according to PLoS Medicine 4, 5

Treatment Algorithm

• If emotional lability is part of bipolar disorder, consider valproate as part of standard therapy, as recommended by the American Academy of Child and Adolescent Psychiatry and PLoS Medicine 1, 6
• Adjunctive psychological treatments, such as relaxation therapy or cognitive behavioral therapy, may enhance outcomes when combined with valproate, as suggested by PLoS Medicine 4

Clinical Pitfalls and Caveats

• Do not use valproate as monotherapy for emotional lability without a clear diagnosis of a condition for which it has demonstrated efficacy, as advised by the American Academy of Child and Adolescent Psychiatry 1, 2