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BACKGROUND Verapamil has been studied as an alternative to lithium for treatment of acute mania and its prophylaxis. This study was undertaken to compare the efficacy and ECG changes in patients receiving lithium and patients receiving verapamil for treatment of acute mania. MATERIALS AND METHODS 50 subjects of acute mania were randomized to receive lithium (n=25) Group A and verapamil (n=25) Group B in 4 weeks double blind parallel group comparative study. Both groups were homogeneous with regard to demographic and disease variables. After giving first dose of verapamil and lithium, ECGs were recorded at base line, 7 th , and 28 th days of trial and subjected to unpaired and paired t-test. p<0.05 was considered statistically significant. Efficacy parameters were recorded 48 hourly during first week and twice a week thereafter. Ordinal data was analysed by non-parametric and true interval by parametric tests. Probability test used to compare patients and disease characteristics. RESULTS Both groups improved significantly (p>0.05) from baseline over a period of 28 days as per Bech-Raefelson Mania Rating Scale (BRMRS) score and attendants' assessment relief report and both groups showed no major differences in ECG changes during trial. However, Verapamil produces more bradycardia and T wave depression. CONCLUSION Verapamil is equally effective alternative to lithium for control of acute mania over a short period. However, baseline and periodic ECG monitoring is required to avoid cardiac toxicity with verapamil. Therefore, it is suggested to compare safety and efficacy by conducting long term and large sample size studies.