Objective: Mood stabilizers are frequently used in the management of acute mania. Lithium has been used for this indication since Cade first described its effectiveness in psychotic excitation in 1949. Carbamazepine and valproate are also accepted as effective antimanic agents. Whether one of these agents is more effective than others is still a matter of discussion. Our aims have been to clarify this issue and to see which one has a faster onset of action.
Methods: We compared the clinical efficacy of lithium, carbamazepine and valproate in 30 inpatients with acute mania. Diagnoses were made according to DSM-IV criteria. There were 10 patients on each arm. Clinical efficacy was assessed weekly by Bech-Rafaelsen Mania Scale, Brief Psychiatric Rating Scale, and Clinical Global Impressions Scale for six weeks. Serum levels of study drugs were obtained weekly in order to maintain recommended serum levels. We referred to neuroleptics for excitation when really necessary, and the amount used was recorded as chlorpromazine equivalents.
Results: During weekly assessments and at the end of the study, none of the drugs was superior to each other neither in antimanic efficacy nor in the week the efficacy began at. All of study drugs reduced assessment scale scores significantly at the end of third week. The amount of neuroleptics used was not different among the patient groups.
Conclusions: Lithium, carbamazepine and valproate are efficacious antimanic agents that have no superiority on each other in treatment of acute mania, but these findings need to be replicated in larger studies.