Valproate Induced Agitation and Irritability in a Patient With Mania: Case Report

Valproate is a mood-stabilizing anticonvulsant. It is also used in the management of agitation, irritability and impulsive aggressive behavior. Here we report on a 35-year-old male with bipolar disorder who had paradoxical agitation and irritability during valproate therapy. He had bipolar disorder for ten years and he was hospitalized due to his manic episode. At the time of admission he was euphoric but not irritable. He was put on valproate and diazepam. On the fourth day of valproate therapy he became irritable, agitated and hostile. Careful investigation of his previous health records showed that he had had a history of agitation and violence in the past while he was on valproate therapy. His agitation and irritability improved rapidly after discontinuation of valproate. He was discharged from the hospital in remission after two weeks of therapy with lithium. If a patient develops new-onset agitation and irritability or worsening of agitation and irritability after starting valproate for the treatment of agitation and aggression, one needs to consider that this may be a manifestation of an adverse effect of valproate.