As published by The Lancet and then was quoted by Medicalnewstoday, antipsychotic drugs have better efficacy than mood stabilizers in treating acute manic episodes. The researchers categorized antipsychotic drug according to the effectiveness and revealed that there are three drugs in particular outperformed other medications. Drugs haloperidol, olanzapine and risperidone. See previuos review of new research in antimanic for effectiveness of treatment for acute mania.
Andrea Cipriani, Section of Psychiatry and Clinical Psychology at the University of Verona, Italy, and John Geddes, Professor of Epidemiological Psychiatry at the University of Oxford, UK, who led the research project, commented that the findings in his research can provide useful clinical guidelines for treatment of acute manic episode, as the current guidelines not differentiate between drugs.
Approximately 1% of the population is affected by Mania, which is defined as "mood disorders that excessive and increased mood". If manic episode alternating with depression, it will describe the diagnosis of bipolar disorder.
In the experiment between January 1, 1980 and 25 November 2010, Cipriani together with his colleagues provide the most common drug to treat acute mania in adults by evaluating the results of 68 randomized controlled trials involving 16 073 participants. The findings of the experiment revealed that the most effective antimanic drug is haloperidol, olanzapine and risperidone, with haloperidol having the highest number of significant differences in the ratio of head-to-head, beat aripiprazole, asenapine, carbamazepine, valproate, gabapentin, lamotrigine, lithium, quetiapine, topiramate, and ziprasidone. This study suggests that risperidone, olanzapine, and quetiapine are the most likely result in treatment discontinuation and proved more effective than mood stabilizers such as lithium, lamotrigine, topiramate, and gabapentin.
The researchers state that these results have potential clinical implications that should be considered in the development of clinical practice guidelines for acute mania. Strikingly, some antipsychotic drugs were, overall, significantly more effective to treat of acute mania than to make mood stabilizers. However, they caution that, "All statements comparing the merits of one medicine with another must be tempered by the potential biases and uncertainties that result from choice of dose and choice of patients."
In a concluding statement, the authors highlight the need for new treatments of acute mania to show either greater efficacy or acceptability than the existing best standard treatments of acute mania and serve as a disincentive to the development of drugs that offer little to patients other than increased costs.
Michael Berk at the School of Medicine, Deakin University, Geelong, Victoria, Australia and Gin S Malhi at the CADE Clinic, Department of Psychiatry, Royal North Shore Hospital in Sydney, NSW, Australia say in a linked Comment, "Haloperidol seems to have won the race for pole position in the treatment of acute mania. However, the management of manic episodes or indeed acute therapy, is not the overriding therapeutic imperative in this polyphasic and capricious disorder. Instead, the main goals of treatment of acute mania are attention to long-term mood stability and prophylaxis. The promotion of haloperidol as a first-line drug for acute mania is problematic in this context, since it lacks maintenance efficacy for depression - the predominant clinical state - and indeed carries an inherent risk of incident depression."
Berk and Malhi conclude that these findings are likely to attract much interest and have a substantial effect both on clinical practice guidelines and real world treatment, making it all the more crucial that the true comparative effectiveness and acceptability of antimanic drugs, and their positioning in broader management is understood.
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