Pharmacological interventions for acute bipolar mania: a systematic review of randomized placebo-controlled trials

Smith, Lesley A., Cornelius, Victoria, Warnock, Adrian, Tacchi, Mary Jane and Taylor, David (2007) Pharmacological interventions for acute bipolar mania: a systematic review of randomized placebo-controlled trials Bipolar Disorders, 9, (6), pp. 551-560. (doi:10.1111/j.1399-5618.2007.00468.x).


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Objectives: We conducted a systematic review and meta-analysis of randomized, placebo-controlled trials in acute bipolar mania to summarize available data on drug treatment of mania.

Methods: We included trials of medications licensed in the USA or UK for the treatment of any phase of bipolar disorder. Outcomes investigated were changes in mania scores, attrition, extrapyramidal effects and weight change. Data were combined through meta-analyses.

Results: We included 13 studies (involving 3,089 subjects) and identified 2 studies for each of the following medications: carbamazepine, haloperidol, lithium, olanzapine, quetiapine, risperidone, valproate semisodium and aripiprazole. All drugs showed significant benefit compared with placebo for reduction in mania scores. Compared with placebo, for all antipsychotics pooled, response to treatment (?50% reduction in Young Mania Rating Scale scores) was increased more than 1.7 times [relative risk (RR) = 1.74, 95% confidence interval (CI) = 1.54, 1.96]; for all mood stabilizers pooled, response to treatment was doubled (RR 2.01, 95% CI = 1.66, 2.43). Overall withdrawals were 34% fewer (24–43%) with antipsychotics, and 26% fewer (10–39%) with mood stabilizers. However, for carbamazepine, aripiprazole and lithium an increase in risk of withdrawal could not be excluded. Small but significant increases in extrapyramidal side effects occurred with risperidone and aripiprazole.

Conclusions: Antipsychotics and mood stabilizers are significantly more effective than placebo for the treatment of acute mania. Their effect sizes are similar. Small differences between effect sizes may be due to differences in the patients included in the studies or to chance. Carbamazepine and lithium may be more poorly tolerated, and antipsychotics cause more extrapyramidal side effects.

Item Type: Article
Digital Object Identifier (DOI): doi:10.1111/j.1399-5618.2007.00468.x
ISSNs: 1398-5647 (print)
Related URLs:
Keywords: antipsychotics, mania, meta-analysis, mood stabilizers, randomized controlled study

ePrint ID: 162293
Date :
Date Event
September 2007Published
Date Deposited: 18 Aug 2010 09:20
Last Modified: 18 Apr 2017 03:46
Further Information:Google Scholar

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