Science and Technology

Antipsychotics are better than mood stabilizers to control manic

Researchers compared the efficacy and side effects of drugs used to treat bipolar

The manic episodes suffered by those with bipolar disorder are better controlled than by antipsychotic drugs, mood stabilizers, the study suggests.

Researchers from Italy and the UK also found that three antipsychotics - the first generation of haloperidol (Haldol), along with later formulations of risperidone (Risperdal) and olanzapine (Zyprexa) - beat 11 other drugs. The scientists analyzed the results of 68 randomized controlled trials with over 16,000 participants over a period of 30 years.

Mania usually alternates with depression in people with bipolar disorder, which tends to occur in families and starts between the ages of 15 and 25 years, according to the U. S. National Institutes of Health. Acute manic episodes characterized by hyperactivity, racing thoughts and reckless behavior are not experienced by all bipolar patients, but severe symptoms often require hospitalization, health officials said.

Broadly defined as a manic related to "extreme variation of mood" affects about 1% of the population, according to the study authors.

"The most important point is that this is a study on the acute treatment of manic episodes, and not long term or preventive action. The idea that antipsychotics are good for manic episodes is well known, but the fact that a the older is the best for this is worthy of reporting, "said psychiatrist Gregory Simon.

Antipsychotics and other drugs used to treat mania are known to have many side effects, which can sometimes hinder the treatment. Co-author of the study, Andrea Cipriani, a professor of psychiatry at the University of Verona, Italy, said that haloperidol and risperidone are more likely than olanzapine to cause movement problems such as tremors and rigidity, the side effects of olanzapine are linked to higher rates of weight gain, metabolic syndrome and diabetes. Some antipsychotics may also cause irregular heartbeats.

Cipriani said that this was the first survey of its kind to compare anti-manic drugs - including antipsychotics, anticonvulsants and lithium - and classify them according to effectiveness and ability to be tolerated. She and her colleagues found a similar study on antidepressants for several years.

Comparing the drugs, the study authors found that haloperidol was more effective than aripiprazole, asenapine, carbamazepine, valproate, gabapentin, lamotrigine, lithium, quetiapine, ziprasidone and topiramate. Risperidone, olanzapine and quetiapine were more likely to be tolerated by patients and surpassed lithium, lamotrigine, topiramate and gabapentin.

"Psychiatrists now have a hierarchy based on evidence for prescribing an anti-manic agent for acute mania. There are new treatments that have recently been marketed for acute mania, but this study shows that clinicians should be aware that these new compounds are not the best - can be even worse - than older ones and are more expensive, "said Cipriani.

The long-term care of bipolar disorder usually requires a combination of drugs, according to Cipriani and Simon, and antipsychotics are generally used for extreme manic episodes by at most a few weeks at a time.

In a commentary accompanying the study, Australian researchers Michael Berk and S. Gin Malhidisseram it is useful to know that haloperidol seems to be a first-line treatment for acute mania. But, they added, haloperidol lacks "the effectiveness of maintenance for depression - the prevailing clinical status [of patients with bipolar disorder] - and in fact carries an inherent risk of incident depression."