Quetiapine with lithium or divalproex for the treatment of bipolar mania: a randomized, double‐blind, placebo‐controlled study

Sachs, Gary S.; Chengappa, K. N. Roy; Suppes, Trisha; Mullen, Jamie; Brecher, Martin; Devine, Naomi; Sweitzer, Dennis

doi:10.1111/j.1399-5618.2004.00115.x

Cited by 225 publications

(128 citation statements)

References 31 publications

(42 reference statements)

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“…Quetiapine has been studied in acute mania in two monotherapy and two adjunctive therapy randomized, placebo-controlled trials (17,(49)(50)(51)(52) (17). In a separate double-blind trial, quetiapine, lithium, and placebo were randomly administered to patients with bipolar mania.…”

Section: Quetiapinementioning

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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Section: Quetiapinementioning

confidence: 99%

Antipsychotic agents in the treatment of bipolar mania

Tohen

Vieta

2009

Bipolar Disorders

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“…We included eight RCTs with 1124 participants (21)(22)(23)(24)(25)(26)(27)(28). Table 1 shows details of the included trials, including the diagnostic criteria used, participant characteristics, dosing regimens, prior treatment, outcome measures, follow-up periods and quality components.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Two compared different co-therapies (23,25). Antipsychotic drugs investigated were haloperidol in three (22,23,25), olanzapine in one (26), quetiapine in two (21,24) risperidone in two (23,28) and ziprasidone in one (27). All included participants with bipolar disorder according to DSM-IV or DSM-III criteria with the exception of one that used criteria of Feighner (22).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All included participants with bipolar disorder according to DSM-IV or DSM-III criteria with the exception of one that used criteria of Feighner (22). All participants were currently manic or with mixed mania; in four studies participants were receiving a mood stabilizer at the time of randomization (23,24,26,28). In the study of Sachs et al (23), 63% of subjects were taking a mood stabilizer, no further details were reported but all randomized participants had YMRS scores of at least 20 at baseline.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…A high proportion of participants withdrew from the studies (range 7-94%), although most studies used intention to treat analyses with last observation carried forward to account for missing data. In one study, a whole centre (n ¼ 20) was excluded from analyses because of a centre-specific protocol violation (24). One analysed study completers only (22).…”

Section: Study Qualitymentioning

confidence: 99%

See 2 more Smart Citations

Acute bipolar mania: a systematic review and meta‐analysis of co‐therapy vs. monotherapy

Smith¹,

Cornelius²,

Warnock

et al. 2006

Acta Psychiatr Scand

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Acute bipolar mania: a systematic review and meta-analysis of co-therapy vs. monotherapy Summations• Adjunct treatment with combined antipsychotics and mood stabilizers is more efficacious than mood stabilizers alone.• Combinations of some drugs are less well tolerated than mood-stabilizer monotherapy. Considerations• All studies included subjects who had already failed to respond to mood stabilizers alone.• The quality of study methods and reporting was variable.Smith LA, Cornelius V, Warnock A, Tacchi MJ, Taylor D. Acute bipolar mania: a systematic review and meta-analysis of co-therapy vs. monotherapy.

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