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Certain antipsychotics 'best for treating mania'

Not all mood stabilising drugs are as effective in treating episodes of mania in patients with bipolar disorder, say the authors of a new analysis.

NICE guidelines currently do not recommend using any particular drug for acute mania. But in data the researchers say may change clinical guidelines, they found antipsychotics such as risperidone, haloperidol and olanzapine were the most effective at treating acute mania, compared with placebo.

The systematic review - published today in The Lancet – looked at 68 randomised controlled trials of thirteen anti-mania drugs and compared their efficacy with placebo.

The trials occurred over a 20 year period, up to the end of 2010, and included male and female patients over 18 years of age who had been diagnosed with bipolar disorder according to the standard diagnostic criteria.

To gauge the efficacy of the different drugs the research team measured the mean change in scores on the Young Mania Rating Scale. They also calculated the patient tolerability to the drugs by recording the number of patients who dropped out of the allocated treatment within the first three weeks. For each of these criteria the drugs were assigned a comparative score out of 50.

Antipsychotic drugs averaged a combined score of 64, whilst other mood stabilisers averaged 31, indicating that antipsychotics are significantly more effective at treating acute mania. The drugs risperidone, haloperidol and olanzapine proved the most the effective, top scoring with 87, 79 and 75 respectively

‘These results have potential clinical implications that should be considered in the development of clinical practice guidelines' the UK and European authors said, before adding ‘results from this study emphasise the need for new treatment to show either greater efficacy or acceptability than the existing best standard treatments'.

In a linked editorial, Professor Michael Berk, chair in psychiatry at Deakin University, Australia, said: ‘Haloperidol seems to have won the race for pole position in the treatment of acute mania.'

‘However, the management of manic episodes, or indeed acute therapy per se, is not the overriding therapeutic imperative in this polyphasic and capricious disorder. Instead, the main goals of treatment are attention to long-term mood stability and prophylaxis.'

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