Olanzapine Versus Divalproex Versus Placebo in the Treatment of Mild to Moderate Mania

Tohen, Mauricio; Vieta, Eduard; Goodwin, Guy M.; Sun, Bin; Amsterdam, Jay D.; Banov, Michael D.; Shekhar, Anantha; Aaronson, Scott T.; Bardenstein, L. M.; Grecu-Gaboş, I; Точилов, В А; Prelipceanu, Dan; Oliff, Heather S; Kryzhanovskaya, Ludmila; Bowden, Charles L.

doi:10.4088/jcp.v69n1113

Cited by 78 publications

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“…At three weeks, improvements in mania scores were significant with olanzapine versus placebo but not with divalproex versus olanzapine or placebo. After 12 weeks of treatment, improvements in both active treatment groups were significant versus placebo, but olanzapine was significantly more efficacious than divalproex (48).…”

Section: Pharmacological Treatment Of Manic Episodesmentioning

confidence: 90%

“…As reviewed earlier, a large (n = 521), 12-week RCT comparing divalproex, olanzapine, and placebo in patients with mild to moderate mania found that improvements in mania scores with olanzapine were significantly greater than with placebo after three weeks, and greater than with both divalproex and placebo after 12 weeks (48).…”

Section: Pharmacological Treatment Of Manic Episodesmentioning

confidence: 99%

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Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013

et al. 2012

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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, O’Donovan C, MacQueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Milev R, Bond DJ, Frey BN, Goldstein BI, Lafer B, Birmaher B, Ha K, Nolen WA, Berk M.  Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013.  Bipolar Disord 2012: 00: 000–000. © 2012 John Wiley & Sons A/S.Published by Blackwell Publishing Ltd.The Canadian Network for Mood and Anxiety Treatments published guidelines for the management of bipolar disorder in 2005, with updates in 2007 and 2009. This third update, in conjunction with the International Society for Bipolar Disorders, reviews new evidence and is designed to be used in conjunction with the previous publications.The recommendations for the management of acute mania remain largely unchanged. Lithium, valproate, and several atypical antipsychotic agents continue to be first‐line treatments for acute mania. Monotherapy with asenapine, paliperidone extended release (ER), and divalproex ER, as well as adjunctive asenapine, have been added as first‐line options.For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, as well as olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first‐line options. Lurasidone monotherapy and the combination of lurasidone or lamotrigine plus lithium or divalproex have been added as a second‐line options. Ziprasidone alone or as adjunctive therapy, and adjunctive levetiracetam have been added as not‐recommended options for the treatment of bipolar depression. Lithium, lamotrigine, valproate, olanzapine, quetiapine, aripiprazole, risperidone long‐acting injection, and adjunctive ziprasidone continue to be first‐line options for maintenance treatment of bipolar disorder. Asenapine alone or as adjunctive therapy have been added as third‐line options.

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Section: Pharmacological Treatment Of Manic Episodesmentioning

confidence: 90%

Section: Pharmacological Treatment Of Manic Episodesmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013

et al. 2012

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“…Moreover, all of the trials considered were very short (approximately only 2 weeks, when drop-out rates are considered), raising the possibility that speed-of-clinical action may favor the antipsychotics, especially through their almost immediate nonspecific or sedating actions (Baldessarini and Tarazi, 2005). As full clinical recovery from acute mania typically requires many weeks, the effects of SGAs versus MSs should be followed for longer times (Bowden et al, 2008;Tohen et al, 2008;Vieta et al, 2010b). In the absence of such long term, direct comparisons, one can consider the similar effect sizes of MSs and SGAs, the established neuroprotective and neurotrophic effects of MSs (Chang et al, 2009;Manji et al, 2000), and the long-term adverse metabolic effects of some SGAs (Baldessarini and Tarazi, 2005) in attempting to compare these classes of effective antimanic agents for clinical selection in the treatment of acute mania.…”

Section: Efficacy Of Agents and Groups Of Agentsmentioning

confidence: 99%

Efficacy of Antimanic Treatments: Meta-analysis of Randomized, Controlled Trials

Yıldız

Vieta

Leucht

et al. 2010

Neuropsychopharmacol

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228

172

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We conducted meta-analyses of findings from randomized, placebo-controlled, short-term trials for acute mania in manic or mixed states of DSM (III-IV) bipolar I disorder in 56 drug-placebo comparisons of 17 agents from 38 studies involving 10 800 patients. Of drugs tested, 13 (76%) were more effective than placebo: aripiprazole, asenapine, carbamazepine, cariprazine, haloperidol, lithium, olanzapine, paliperdone, quetiapine, risperidone, tamoxifen, valproate, and ziprasidone. Their pooled effect size for mania improvement (Hedges' g in 48 trials) was 0.42 (confidence interval (CI): 0.36-0.48); pooled responder risk ratio (46 trials) was 1.52 (CI: 1.42-1.62); responder rate difference (RD) was 17% (drug: 48%, placebo: 31%), yielding an estimated number-needed-to-treat of 6 (all po0.0001). In several direct comparisons, responses to various antipsychotics were somewhat greater or more rapid than lithium, valproate, or carbamazepine; lithium did not differ from valproate, nor did second generation antipsychotics differ from haloperidol. Meta-regression associated higher study site counts, as well as subject number with greater placebo (not drug) response; and higher baseline mania score with greater drug (not placebo) response. Most effective agents had moderate effect-sizes (Hedges' g ¼ 0.26-0.46); limited data indicated large effect sizes (Hedges' g ¼ 0.51-2.32) for: carbamazepine, cariprazine, haloperidol, risperidone, and tamoxifen. The findings support the efficacy of most clinically used antimanic treatments, but encourage more head-to-head studies and development of agents with even greater efficacy.

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“…Olanzapine-treated patients experienced more somnolence, weight gain, rhinitis, edema, and slurred speech than divalproex-treated patients. More recently, a placebo-controlled study compared olanzapine versus divalproex at three and 12 weeks in patients with mild to moderate nonpsychotic mania (45). The placebo arm was limited to three weeks.…”

Section: Olanzapinementioning

confidence: 99%

Antipsychotic agents in the treatment of bipolar mania

Tohen

Vieta

2009

Bipolar Disorders

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Objectives: Antipsychotics have been widely used in the treatment of bipolar mania. The purpose of this manuscript was to briefly review the evidence of typical and atypical antipsychotics for the treatment of bipolar mania.Methods: A detailed literature review was conducted on the use of typical and atypical antipsychotics in the treatment of bipolar mania using standard search engines. A summary of the published literature on each agent is described followed by a discussion on the overall comparison of the different agents.Results: For typical antipsychotics, up until recently, there was a paucity of published evidence on their strengths and limitations in the treatment of bipolar mania. Recent studies have demonstrated clear evidence on the efficacy of haloperidol on the treatment of acute mania. The literature suggests a faster onset of action of haloperidol as compared to either lithium or atypical antipsychotics. A limitation of typical antipsychotics however, is the risk of tardive dyskinesia, extrapyramidal side effects and a possible increased risk of non‐adherence. Evidence on the efficacy for atypical antipsychotics has been demonstrated for aripiprazole, clozapine, olanzapine, quetiapine, risperidone and ziprasidone. Limitations as regards the use of atypical antipsychotics include the risk of weight gain and dyslipidemia. Comparison among different atypical antipsychotics agents are difficult to determine as there are no conclusive head to head studies. There is also a paucity of studies comparing atypical antipsychotics with lithium.Conclusions: Evidence exists on the efficacy of both typical and atypical antipsychotics on the treatment of acute mania such that they are now clearly first‐line along with lithium. An important limitation of the published literature is that most of the studies were designed to obtain regulatory approval for the different agents therefore the generalizability of the findings to clinical practice remains unclear.

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Olanzapine Versus Divalproex Versus Placebo in the Treatment of Mild to Moderate Mania

Cited by 78 publications

References 0 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013

Efficacy of Antimanic Treatments: Meta-analysis of Randomized, Controlled Trials

Antipsychotic agents in the treatment of bipolar mania

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