Cipriani said the new research was the first of its type to compare anti-manic drugs -- including antipsychotics, anticonvulsants and lithium -- and rank them according to their effectiveness and ability to be tolerated. She and her colleagues completed a similar study on antidepressants several years ago.
In head-to-head comparisons among drugs, the study authors found that haloperidol was more effective than aripiprazole, asenapine, carbamazepine, valproate, gabapentin, lamotrigine, lithium, quetiapine, topiramate and ziprasidone. Risperidone, olanzapine and quetiapine were most likely to be tolerated by patients and outperformed lithium, lamotrigine, topiramate and gabapentin.
The new research, which was not funded by the pharmaceutical industry, appears in the Aug. 17 online edition of The Lancet.
"Psychiatrists now have an evidence-based hierarchy when they are to prescribe an anti-manic agent for acute mania," Cipriani said. "These findings are in line with what psychiatrists usually prescribe in their daily practice. There are new treatments that have been recently marketed for acute mania, but this study shows that clinicians should be aware these new compounds are not better -- and may be worse -- than older ones, and these [new] drugs are much more expensive."
Long-term management of bipolar disorder usually requires a combination of medications, Cipriani and Simon said, and antipsychotics typically are used for extreme manic episodes for only several weeks at a time.
In a commentary accompanying the study, Australian researchers Dr. Michael Berk, chair of psychiatry at the Deakin University School of Medicine, and Gin S. Malhi, with the department of psychiatry at Royal North Shore Hospital in Sydney, said it's useful to know
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