Kabadayi Sahin E. Lithium and valproic acid in bipolar disorder: Beyond mood stabilization, the overlooked role of sleep. World J Psychiatry 2025; 15(12): 113893 [PMID: 41357913 DOI: 10.5498/wjp.v15.i12.113893]
Corresponding Author of This Article
Esra Kabadayi Sahin, MD, Associate Professor, Department of Psychiatry, Ankara Yildirim Beyazit University Faculty of Medicine, Universiteler Mahallesi, Cankaya, Ankara 06800, Türkiye. ekabadayi06@gmail.com
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Psychiatry
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Letter to the Editor
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 19, 2025 (publication date) through Dec 9, 2025
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World Journal of Psychiatry
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2220-3206
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Kabadayi Sahin E. Lithium and valproic acid in bipolar disorder: Beyond mood stabilization, the overlooked role of sleep. World J Psychiatry 2025; 15(12): 113893 [PMID: 41357913 DOI: 10.5498/wjp.v15.i12.113893]
World J Psychiatry. Dec 19, 2025; 15(12): 113893 Published online Dec 19, 2025. doi: 10.5498/wjp.v15.i12.113893
Lithium and valproic acid in bipolar disorder: Beyond mood stabilization, the overlooked role of sleep
Esra Kabadayi Sahin
Esra Kabadayi Sahin, Department of Psychiatry, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara 06800, Türkiye
Author contributions: Kabadayi Sahin E contributed to the conceptualization, writing, reviewing, and editing of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Esra Kabadayi Sahin, MD, Associate Professor, Department of Psychiatry, Ankara Yildirim Beyazit University Faculty of Medicine, Universiteler Mahallesi, Cankaya, Ankara 06800, Türkiye. ekabadayi06@gmail.com
Received: September 5, 2025 Revised: September 17, 2025 Accepted: October 11, 2025 Published online: December 19, 2025 Processing time: 83 Days and 1.2 Hours
Abstract
Sleep is a critical yet often underestimated physiological parameter in psychiatric disorders. In their article, Gokcay et al examined sleep quality in bipolar disorder patients treated with lithium or valproic acid, showing lithium’s advantage in habitual sleep efficiency and reduced disturbances. While this study provides valuable data in a chronic and clinically challenging cohort, reliance solely on self-reported sleep measures remains a limitation. Polysomnography, although the gold standard, is not always practical; therefore, actigraphy and wearable technologies represent feasible alternatives to capture objective sleep patterns. This letter emphasizes the importance of integrating objective, scalable technologies and pharmacological monitoring into longitudinal designs to clarify whether improvements in sleep translate into better clinical outcomes and reduced relapse risk in bipolar disorder.
Core Tip: This letter emphasizes the importance of evaluating sleep as a central physiological parameter in bipolar disorder. While the original study demonstrated lithium's advantage over valproic acid in sleep quality. It is highlighted that reliance solely on self-reported scales is a limitation. Wearable technologies and actigraphy offer objective, scalable alternatives to polysomnography. Future studies should integrate serum drug-level monitoring and adjunctive antipsychotic data into longitudinal designs to clarify how mood stabilizers influence sleep and to advance personalized treatment strategies in bipolar disorder.
