A study published last week entitled “Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis” (Cipriani et al The Lancet 17 Aug 2011) reviewed many previous trials of medications for mania. It looked at results for any of the following medications: Aripiprazole (Abilify) , asenapine (Saphris), carbamazepine (Tegretol) , valproate (Depakote) , gabapentin (Neurontin), haloperidol (Haldol), Lamotrigine (Lamictal), lithium, Olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal) , topiramate (Topamax), and Ziprasidone (Geodon).

This study was not looking at maintenance; it wasn’t looking at the best preventive. The study focused on controlling a manic episode. The study found:

• Lithium, the atypical antipsychotics, Haldol (a “typical”or first generation antipsychotic), and the anticonvulsants were all better than placebo.
• Neurontin, Topamax, and Lamotrigine were not more effective than placebo.
• Interestingly Haldol was the most effective – beyond lithium and all of the atypical antipsychotics.
• Risperidone and Zyprexa were more effective than Depakote and Geodon.
• Risperiodne, Zyprexa, and Geodon were associated with the fewest people stopping the medicines.

Their conclusion is that for treating acute mania, the antipsychotics were most effective, even over standard mood stabilizers, and the old fashioned antipsychotic Haldol was actually an excellent choice.

This study offers an interesting perspective, given that we often load up on mood stabilizers and anticonvulsants to control a manic episode. And it also encourages doctors to at least consider the older, less expensive medications such as Haldol as an option, rather than defaulting to the newest/fanciest/most expensive medicine available.

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    Last reviewed: 25 Aug 2011