A review of randomized, controlled clinical trials in acute mania

Keck, Paul E.; Mendlwicz, Julien; Calabrese, Joseph R.; Fawcett, Jan; Suppes, Trisha; Vestergaard, Per; Carbonell, Carlos

doi:10.1016/s0165-0327(00)00177-4

Cited by 48 publications

(26 citation statements)

References 35 publications

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“…Of the nine children for whom no treatment tried appeared to help during hospitalization, antimanic drugs like lithium, haloperidol, and prolixin were tried in cases where time permitted (although children were kept on average 10-12 weeks, they were not kept interminably). Data gathered in adults since then indicate that lithium at least is not helpful in this kind of mania (Abou-Saleh 1993; Keck et al 2000). Phenomenologically, however, many of the most nonresponsive children had developmental disorders in which executive function and emotional dyscontrol were primary.…”

Section: Drug-induced Disinhibition 159mentioning

confidence: 99%

Drug-Induced Disinhibition in Psychiatrically Hospitalized Children

Carlson

Mick

2003

Journal of Child and Adolescent Psychopharmacology

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Section: Drug-induced Disinhibition 159mentioning

confidence: 99%

Drug-Induced Disinhibition in Psychiatrically Hospitalized Children

Carlson

Mick

2003

Journal of Child and Adolescent Psychopharmacology

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“…Hence, our findings apply mostly to valproate. Whereas its efficacy in acute mania [32] and possibly in the long-term maintenance treatment of bipolar disorder [33] is supported by double-blind placebo controlled trials, there are no controlled trials on its efficacy in depression with dysphoric mood. Interestingly, there is no agreed definition of the term 'mood stabiliser'.…”

Section: Resultsmentioning

confidence: 99%

Untitled

Pasquini¹,

Picardi²,

Speca³

et al. 2007

Clin Pract Epidemiol Ment Health

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BackgroundSeveral patients with unipolar depression present with prominent dysphoric mood. We aimed at examining the effectiveness of the combination of an SSRI with an anticonvulsant in such patients.MethodsThirty-five newly admitted outpatients with substantial anger, irritability, aggressiveness or hostility who were diagnosed a DSM-IV unipolar depressive disorder were rated on the Hamilton Depression Rating Scale (HDRS), the Clinical Global Improvement (CGI) scale, and a scale for the rapid dimensional assessment (SVARAD), were prescribed an SSRI and an anticonvulsant (usually valproate), and were followed up for 12 weeks. Repeated measures analysis of variance was used to test for within-subject changes in scale scores over time.ResultsThirty-two and 23 patients attended the follow-up visits 4 and 12 weeks later, respectively. Significant decreases (p < .001) were observed in HDRS total score, HDRS and SVARAD anxiety factors, HDRS and SVARAD core depression factors, and SVARAD anger/irritability factor. Adjusting for age or gender did not change the results. Most patients (82%) were rated as improved or much improved on the CGI.ConclusionAlthough our study has several limitations, we observed a remarkable improvement in most unipolar depressed outpatients with dysphoric mood treated with an SSRI and an anticonvulsant. The effectiveness of anticonvulsants might be linked to their action on symptoms of aggression and behavioural activation.

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“…Mood-disordered patients have a higher risk of this side effect from neuroleptics. 71 It is routine to add an oral benzodiazepine such as lorazepam or clonazepam to antipsychotics for additional shortterm sedation as an alternative to increasing the dose of the primary antimanic agent(s). 8,15 The evidence supporting this practice with mania patients, however, is sparse.…”

Section: Continued On Next Pagementioning

confidence: 99%

“…71 One study compared response to lithium versus valproate in four subtypes of mania (anxious-depressive, psychotic, classic, and irritable-dysphoric subtypes). In the psychotic type, lithium was significantly more likely to lower mania ratings by 50%.…”

Section: Continued On Next Pagementioning

confidence: 99%

The Psychopharmacology Algorithm Project at the Harvard South Shore Program

Mohammad

Osser

2014

Harvard Review of Psychiatry

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This new algorithm for the pharmacotherapy of acute mania was developed by the Psychopharmacology Algorithm Project at the Harvard South Shore Program. The authors conducted a literature search in PubMed and reviewed key studies, other algorithms and guidelines, and their references. Treatments were prioritized considering three main considerations: (1) effectiveness in treating the current episode, (2) preventing potential relapses to depression, and (3) minimizing side effects over the short and long term. The algorithm presupposes that clinicians have made an accurate diagnosis, decided how to manage contributing medical causes (including substance misuse), discontinued antidepressants, and considered the patient's childbearing potential. We propose different algorithms for mixed and nonmixed mania. Patients with mixed mania may be treated first with a second-generation antipsychotic, of which the first choice is quetiapine because of its greater efficacy for depressive symptoms and episodes in bipolar disorder. Valproate and then either lithium or carbamazepine may be added. For nonmixed mania, lithium is the first-line recommendation. A second-generation antipsychotic can be added. Again, quetiapine is favored, but if quetiapine is unacceptable, risperidone is the next choice. Olanzapine is not considered a first-line treatment due to its long-term side effects, but it could be second-line. If the patient, whether mixed or nonmixed, is still refractory to the above medications, then depending on what has already been tried, consider carbamazepine, haloperidol, olanzapine, risperidone, and valproate first tier; aripiprazole, asenapine, and ziprasidone second tier; and clozapine third tier (because of its weaker evidence base and greater side effects). Electroconvulsive therapy may be considered at any point in the algorithm if the patient has a history of positive response or is intolerant of medications.

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A review of randomized, controlled clinical trials in acute mania

Cited by 48 publications

References 35 publications

Drug-Induced Disinhibition in Psychiatrically Hospitalized Children

Drug-Induced Disinhibition in Psychiatrically Hospitalized Children

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The Psychopharmacology Algorithm Project at the Harvard South Shore Program

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