Episodes of acute mania in adults are treated more effectively with antipsychotic drugs than mood stabilisers such as anticonvulsants and lithium, according to a study published today in The Lancet.
The researchers carried out a meta-analysis of 68 randomised clinical trials published between 1980 and 2010 comparing the most commonly-used drugs used in the treatment of acute mania, which affects around 1% of people and along with depression is a component of bipolar disorder.
"Overall, antipsychotic drugs were significantly more effective than mood stabilisers," said the research team, led by Dr. Andrea Cipriani at the University of Verona in Italy and Professor John Geddes of Oxford University in the UK.
Among the antipsychotic drugs under evaluation, Johnson & Johnson's Risperdal (risperidone), Eli Lilly's Zyprexa (olanzapine) and generic haloperidol should be considered as among the best of the available options for the treatment of manic episodes, they report.
Of these, generic haloperidol performed the best, but all three antipsychotics were much better than mood stabilisers in the mean change on mania rating scales and the number of patients who dropped out of the allocated treatment at three weeks. Some commonly-used drugs - including the anticonvulsants gabapentin, lamotrigine and topiramate - performed no better than placebo.
"These results should be considered in the development of clinical practice guidelines," write the authors. Current guidelines make no distinction between the various drugs that can be used in this setting.
An editorial accompanying the study, written by Michael Berk of Deakin University and Gin Malhi of Royal North Shore Hospital, both in Australia, agreed that generic haloperidol seems to have come top of the rankings in the study, but offered a word of caution.
The treatment of manic episodes is not generally the "overriding therapeutic imperative" of treatment, they note, rather it is long-term mood stability and the prevention of manic episodes, given that depression is often the dominant feature in bipolar disorder.
Drugs compared in the meta-analysis included aripiprazole, asenapine, carbamazepine, valproate, gabapentin, haloperidol, lamotrigine, lithium, olanzapine, quetiapine, risperidone, topiramate, and ziprasidone.