Walton SA, Berk M, Brook S.
of Psychiatry, University of the Witwatersrand Medical School, Johannesburg, South
Superiority of lithium over verapamil in mania: a randomized,
controlled, single-blind trial.
J Clin Psychiatry. 1996
"BACKGROUND: Both case reports and small controlled
studies suggest the efficacy of verapamil in the treatment of mania. METHOD: Forty
patients with DSM-IV mania were studied in a 28-day randomized, controlled, single-blind
trial of either lithium or verapamil. RESULTS: The patients receiving lithium
showed a significant improvement on all rating scales (Brief Psychiatric Rating
Scale [BPRS], Mania Rating Scale [MRS], Global Assessment of Functioning [GAF],
and Clinical Global Impression [CGI]) compared with those receiving verapamil.
The mean MRS score at Day 28 in the lithium group was significantly lower than
that in the verapamil group (17.47 vs. 24.43, respectively; F = 6.17, df = 1,
p = .018). A similar pattern was seen with the BPRS (12.68 vs. 20.57; F = 10.69,
df = 1, p = .002), CGI (2.31 vs. 3.33; F = 6.05, df = 1, p = .019), and GAF (43.52
vs. 52.31; F = 4.36, df = 1, p = .044) (ANCOVA). CONCLUSION: This study suggests
that lithium is superior to verapamil in the management of acute mania."
Stoll AL, Severus WE, Freeman MP, Rueter S, Zboyan
HA, Diamond E, Cress KK, Marangell LB.
Brigham and Women's Hospital, Department
of Psychiatry, Harvard Medical School, Boston, Mass, USA. email@example.com
3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled
Arch Gen Psychiatry. 1999 May;56(5):407-12.
Omega3 fatty acids may inhibit neuronal signal transduction pathways in a manner
similar to that of lithium carbonate and valproate, 2 effective treatments for
bipolar disorder. The present study was performed to examine whether omega3 fatty
acids also exhibit mood-stabilizing properties in bipolar disorder. METHODS: A
4-month, double-blind, placebo-controlled study, comparing omega3 fatty acids
(9.6 g/d) vs placebo (olive oil), in addition to usual treatment, in 30 patients
with bipolar disorder. RESULTS: A Kaplan-Meier survival analysis of the cohort
found that the omega3 fatty acid patient group had a significantly longer period
of remission than the placebo group (P = .002; Mantel-Cox). In addition, for nearly
every other outcome measure, the omega3 fatty acid group performed better than
the placebo group. CONCLUSION: Omega3 fatty acids were well tolerated and improved
the short-term course of illness in this preliminary study of patients with bipolar
AC, Crockatt JG, Janney CA, Werth JL, Tsaroucha G.
Research, Division of Warner-Lambert Company, Ann Arbor, MI 48105, USA.
in bipolar disorder: a placebo-controlled trial of adjunctive therapy. Gabapentin
Bipolar Disorder Study Group.
Bipolar Disord. 2000 Sep;2(3
"OHJECTIVES: To assess efficacy and safety of gabapentin
in the treatment of bipolar disorder. METHODS: This was a double-blind, placebo-controlled
trial of adjunctive gabapentin (dosed flexibly between 900 and 3,600 mg/day).
Patients with a lifetime diagnosis of bipolar disorder (type I), and who were
currently suffering from symptoms of either mania, hypomania or a mixed state
despite ongoing therapy with lithium, valproate, or lithium and valproate in combination
were eligible for inclusion. The primary efficacy measures were the baseline to
endpoint change in total score on the Young Mania Rating Scale (YMRS) and the
Hamilton Depression Rating Scale (HAM-D). RESULTS: Both treatment groups had a
decrease in total YMRS from baseline to endpoint, but this decrease was significantly
greater in the placebo group (-9) than the gabapentin group (-6) (p < 0.05).
No difference between treatments was found for the total score on the HAM-D. Secondary
efficacy measures were not different between treatment groups. More patients in
the placebo group had changes made to their ongoing lithium therapy (n = 12) compared
to the gabapentin group (n = 4). When these patients are removed from the efficacy
analysis, the YMRS treatment difference still favors placebo, but is no longer
statistically significant. Based on gabapentin plasma levels at termination, some
patients did not take the study drug as prescribed. CONCLUSIONS: The findings
of this study did not demonstrate that gabapentin is an effective adjunctive treatment
when administered to outpatients with bipolar disorder." [Abstract]
A, Yaroslavsky Y, Bersudsky Y, Belmaker RH.
Stanley Center for Bipolar Research,
Ministry of Health Mental Health Center, Ben Gurion University of the Negev, Beersheva,
Phenytoin as an antimanic anticonvulsant: a controlled study.
J Psychiatry. 2000 Mar;157(3):463-5.
"OBJECTIVE: Phenytoin, a classical
anticonvulsant, shares with antimanic anticonvulsants the property of blockade
of voltage-activated sodium channels. The authors therefore planned a trial of
phenytoin for mania. METHOD: Patients with either bipolar I disorder, manic type,
or schizoaffective disorder, manic type, entered a 5-week, double-blind controlled
trial of haloperidol plus phenytoin versus haloperidol plus placebo. Of 39 patients,
30 completed at least 3 weeks and 25 completed 5 weeks. RESULTS: Significantly
more improvement was observed in the patients receiving phenytoin. Added improvement
with phenytoin in scores on the Brief Psychiatric Rating Scale and Clinical Global
Impression was seen in the patients with bipolar mania but not those with schizoaffective
mania. CONCLUSIONS: Blockade of voltage-activated sodium channels may be a common
therapeutic mechanism of many anticonvulsants given for mania, and phenytoin may
be a therapeutic option for some manic patients." [Abstract]
PG, Sharma RP, Pandey G, Davis JM.
Psychiatric Institute, University of Illinois
at Chicago 60612, USA.
Verapamil for the treatment of acute mania:
a double-blind, placebo-controlled trial.
Am J Psychiatry.
"OBJECTIVE: This study investigated the efficacy
of verapamil in acute mania. METHOD: The study was a 3-week double-blind, random-assignment,
parallel-group, placebo-controlled inpatient trial of verapamil for patients with
acute mania. Of the 32 study patients, 15 were given placebo and 17 were given
verapamil. RESULTS: Mean absolute change scores on the Mania Rating Scale at endpoint,
with baseline scores as the covariates, did not differ between the verapamil and
placebo groups. There were no significant differences between the two groups in
age, sex, and presence of psychosis. CONCLUSIONS: The investigators found no benefit
of verapamil over placebo in treating acute mania." [Abstract]