Summary

This meta-analysis found that antipsychotics (risperidone, olanzapine, and haloperidol) were significantly more effective than mood stabilizers in treating acute mania. Olanzapine, risperidone, and quetiapine had the lowest dropout rates.

Design

• Multiple-treatments meta-analysis of 68 randomised controlled trials (n=16,073) comparing treatment of acute mania in adults with: aripiprazole, asenapine, carbamazepine, valproate, gabapentin, haloperidol, lamotrigine, lithium, olanzapine, quetiapine, risperidone, topiramate, and ziprasidone.
• Primary outcomes: mean change in rating scales and number who dropped out at 3 weeks.

Results

• Haloperidol, risperidone, olanzapine, lithium, quetiapine, aripiprazole, carbamazepine, asenapine, valproate, and ziprasidone were significantly more effective than placebo.
• Haloperidol was significantly more effective than all other agents, with the exceptions of risperidone and olanzapine.
• Olanzapine, risperidone, and quetiapine were associated with significantly fewer discontinuations than lithium, lamotrigine, topiramate, gabapentin, or placebo.
• Gabapentin, lamotrigine, and topiramate were not significantly more effective than placebo.

Reference

Cipriani A, Barbui C, Salanti G, et al. Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis. Lancet. 2011;378(9799):1306–1315.