Antipsychotic drugs effective in acute mania

January 01, 0001

Antipsychotic drugs effective in acute mania

Conventional meta-analyses have shown inconsistent results for efficacy of pharmacological treatments for acute mania. The researchers from Italy, Greece and the UK did a multiple-treatments meta-analysis, which accounted for both direct and indirect comparisons, to assess the effects of all antimanic drugs. They systematically reviewed 68 randomised controlled trials (16,073 participants) from Jan 1, 1980, to Nov 25, 2010, which compared any of the following pharmacological drugs at therapeutic dose range for the treatment of acute mania in adults: aripiprazole, asenapine, carbamazepine, valproate, gabapentin, haloperidol, lamotrigine, lithium, olanzapine, quetiapine, risperidone, topiramate, and ziprasidone.

Haloperidol (standardised mean difference (SMD) -0.56), risperidone (—0.50), olanzapine (—0.43), lithium (—0.37), quetiapine (—0.37), aripiprazole (—0.37), carbamazepine (—0.36), asenapine (—0.30), valproate (—0.20), and ziprasidone (—0.20) were significantly more effective than placebo, whereas gabapentin, lamotrigine, and topiramate were not. Haloperidol had the highest number of significant differences and was significantly more effective than lithium (SMD -0.19), quetiapine (—0.19), aripiprazole (—0.19), carbamazepine (—0.20), asenapine (—0.26), valproate (—0.36), ziprasidone -0.36), lamotrigine (—0.48), topiramate (—0.63), and gabapentin (—0.88). Risperidone and olanzapine had a very similar profile of comparative efficacy, being more effective than valproate, ziprasidone, lamotrigine, topiramate, and gabapentin. Olanzapine, risperidone, and quetiapine led to significantly fewer discontinuations than did lithium, lamotrigine, placebo, topiramate, and gabapentin.

The researchers concluded: "Overall, antipsychotic drugs were significantly more effective than mood stabilisers. Risperidone, olanzapine, and haloperidol should be considered as among the best of the available options for the treatment of manic episodes. These results should be considered in the development of clinical practice guidelines."

This may represent a whole new approach to the acute phase.

For the full abstract, click here.

The Lancet published online 17 August 2011
© 2011 Elsevier Limited
Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis. Andrea Cipriani, Corrado Barbui, Georgia Salanti et al. Correspondence to Andrea Cipriani:

Category: P. Psychological. Keywords: efficacy, comparative, antimanic drugs, acute mania, multiple-treatments meta-analysis, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 16 September 2011

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