Drug treatments

The drug groups used in the treatment of mania are ‘unfortunately named’ as apart from Lithium, they fall into what are traditonally called  ”antipsychotic” type drugs or “anti-epileptic” type drugs; reflecting their first use in the treatment of psychosis and epilepsy respectively.  However, since that time they have been found to be effective with other conditions.  This is often the case with drugs, for example, amitriptiline was widely used for the treatment of depression but now has a new use in the treatment of chronic pain.

Similarly, the anti-psychotic drugs have been found to be highly effective in patients with mania even when there are no psychotic symptoms present (and indeed some have been found to have efficacy in bipolar depression without psychotic symptoms).

In the USA, as of writing (Summer, 2011), to the best of our knowledge, there are 11 agents approved by the Federal Drug Administration (FDA) for the treatment of Acute Mania. The manner in which the pharmaceutical industry works is that agents tend to get approval first in the US then approval is sought in Europe from the European Medicines Agency (EMEA) for use throughout the EU. They are often launched at different times in different EU countries.

Drug Year of  FDA Approval Notes
Lithium 

 

1970
Chlorpromazine 

 

1973
Depakote 

(semisodium valproate)

1994
Olanzapine 2000 approved for use on its own and as an ‘add on’ therapy
Risperidone 2003 approved for use on its own and as an ‘add on’ therapy
Quetiapine 2004 approved for use on its own and as an ‘add on’ therapy
Ziprazidone 

 

2004
Aripiprazole 

 

2004
Equetro(carbamazepine extended release) 2004
Depakote ER(Extended Release) 2005
Asenapine 

 

2009 and 2010 approved for use on its own in mania(09) and as an ‘add on’ therapy for maintenance(10)

In Europe,in addition to Lithium, the EMEA have approved the following agents for acute mania:

Semisodium Valproate (Depakote), Olanzapine, Risperdone, Quetiapine, Aripiprazole and Asenapine.   The sections on individual drugs gives information from systematic reviews and meta-analyses where available and will be updated as resources become available.