Pharmacotherapy of mania: A review

Abstract

The management of mania is an important and common clinical challenge. A wide array of psychopharmacological alternatives is available, diverse in their mechanism of action. They include lithium, the antipsychotics, anticonvulsants and others. With the exception of lithium, all these agents have been borrowed from other indications. The wide variety of therapeutic options does not help to clarify the primary pathophysiological mechanisms operative in bipolar disorder. While the development of novel therapeutic agents increases the available armamentarium, there is little clarity as to the place of the novel agents in treatment regimens. A further issue in the treatment of mania is the significant divergence of opinion as to choice of first-line antimanic therapy. This paper attempts to review the evidence of efficacy of the various antimanic agents, with a focus on the novel anticonvulsant and neuroleptic drugs, and to discuss the data available on these novel therapeutic options. ( Int J Psych Clin Pract 2000; 4: 171 - 193).

Typical neuroleptics vs. atypical antipsychotics in the treatment of acute mania in a natural setting

“…Bowden et al, 2005 ;Kasper et al, 2002 ;Keck et al, 2003a,b ;Sachs et al, 2002 ;Segal et al, 2000 ;Tohen et al, 1999) atypical antipsychotics can be considered as the first choice as add-on therapy for the treatment of acute mania compared to typical neuroleptics due to their better efficacy, the significantly reduced need of co-medication using benzodiazepines, the significantly less frequency of extrapyramidal side-effects and a tendency for a shorter duration of hospital stay. Bowden et al, 2005 ;Kasper et al, 2002 ;Keck et al, 2003a,b ;Sachs et al, 2002 ;Segal et al, 2000 ;Tohen et al, 1999) atypical antipsychotics can be considered as the first choice as add-on therapy for the treatment of acute mania compared to typical neuroleptics due to their better efficacy, the significantly reduced need of co-medication using benzodiazepines, the significantly less frequency of extrapyramidal side-effects and a tendency for a shorter duration of hospital stay.…”

“…Typical neuroleptics have been shown to have antimanic efficacy (Segal et al, 2000 ;Tohen et al, 2001) and are widely used in daily practice (Letmaier et al, 2004). Furthermore they can be used in an intramuscular injection form in emergency conditions.…”