Risperidone combined with a mood stabilizer was more effective in acute mania than the mood stabilizer alone and as effective as the combination of haloperidol and a mood stabilizer, according to the results of a double-blind, placebo-controlled trial reported in the July issue of the American Journal of Psychiatry. Compared with the haloperidol combination, the risperidone combination had significantly fewer adverse effects and extrapyramidal symptoms.
“To our knowledge, this study provides the first controlled comparison of a typical and atypical antipsychotic in the treatment of mania,” write Gary S. Sachs, MD, from Massachusetts General Hospital in Boston, and colleagues.
In this three-week study, 156 bipolar disorder patients with a current manic or mixed episode were randomized to treatment with a mood stabilizer (lithium or divalproex) and placebo, risperidone, or haloperidol. Mean modal doses were 3.8 mg/day (SD=1.8) of risperidone and 6.2 mg/day (SD=2.9) of haloperidol. Nearly half of patients in the placebo group (25 [49%] of 51) discontinued the trial, as did 18 (35%) of 52 patients in the risperidone group and 28 (53%) of 53 patients in the haloperidol group.
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