Clinical Comparison of Lithium, Valproate, and Antipsychotic in Acute Manic Episode
Ajeet Sidana, Ira U Domun, Prinka Arora, Karan Singh Nagarkoti, Parul Narwar, Vaishali SandalBackground:
There is an array of options available for management of acute mania; however, head-on clinical trials of various molecules on the Indian population are lacking.
Aim and Objectives:
To compare the efficacy of lithium, valproate, and antipsychotic (risperidone and olanzapine) in acute manic episode.
Materials and Methods:
The study was a comparative trial including 5 arms, i.e., lithium (Li), valproate (Va), antipsychotic (AP), mood stabilizer plus antipsychotic (MS + AP), and mood stabilizer plus mood stabilizer (MS + MS). Assessment of severity of symptoms was done using the Young Mania Rating Scale (YMRS) at baseline and after every 48 after subsequently till the score reached to 7. The Brief Psychiatric Rating Scale (BPRS) was applied at baseline and the end of the study.
Results:
A total of 75 patients with acute manic episode; 15 in each arm completed the study. The mean age of the study population was 34.6 years, with 60.9% males. All 5 groups were comparable on the severity of illness at baseline. There was a statistically significant reduction in YMRS and BPRS scores in all 5 groups (
Conclusion:
All 5 groups showed statistically significant improvement in psychopathology within 5 weeks of initiation of treatment. MS + AP shows a statistically significant superiority over the other groups. Tremors were the most commonly reported side effect with lithium.