title: Ritanserin as an adjunct to lithium and haloperidol for the treatment of medication-naive patients with acute mania: a double blind and placebo controlled trial.
abstract: BACKGROUND
  Bipolar disorder is a lifelong episodic condition characterized by mood swings between mania and depression. Several lines of evidence suggest that serotonin is likely to play a pivotal role in the pathophysiology of bipolar disorder. Ritanserin, a 5-HT2 receptor antagonist, has been reported to have antipsychotic activity. In this 6-week double blind, placebo controlled study involving moderate to severe manic patients, we assessed the effects of ritanserin plus haloperidol in combination with lithium.
  
  
  METHODS
  45 patients aged between 21-43 were eligible to participate as they met the DSM-IV criteria for a current manic episode, on the basis of a clinical interview by an academician psychiatrist. In addition, a score of at least 20 points on the Young Mania rating Scale was required representing moderate to severe mania. Patients were randomly allocated lithium (1-1.2 mEq/L) + haloperidol (10 mg/day)+ ritanserin (10 mg/day) (Group A) or lithium (1-1.2 mEq/L)+ haloperidol (10 mg/day) + placebo (Group B) for a 6-week, double-blind, placebo-controlled study. Patients were assessed by a third year psychiatry resident at baseline and 3, 7, 14, 21, 28 and 42 days after the medication started. All patients entered the hospital were not previously under any medication. The mean decrease in the Young Mania Rating Scale score from baseline was used as the main outcome measure of response of mania to treatment. The extrapyramidal symptoms were assessed using the Extrapyramidal Symptoms Rating Scale. Side effects were systematically recorded throughout the study and were assessed using a checklist.
  
  
  RESULTS
  Young Mania Rating Scale total scores improved with ritanserin. The difference between the two protocols was significant as indicated by the effect of group and the between-subjects factor (F = 5.02, d.f. = 1, P = 0.03). The means Extrapyramidal Symptoms Rating Scale scores for the placebo group were higher than the ritanserin group and the difference was significant in day 42. The difference between the two groups in the frequency of side effects was not significant
  
  
  CONCLUSIONS
  The efficacy of ritanserin to obtain a better improvement in patients with mania seems to support the 5-HT hypothesis of bipolar disorder.
authors.affiliation: Pychiatric Research Centre, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Street, Tehran 13185, Iran. s.akhond@neda.net
authors.forename: Shahin
authors.initials: S
authors.lastname: Akhondzadeh
authors.forename: Hassan
authors.initials: H
authors.lastname: Mohajari
authors.forename: Mohammad
authors.initials: M
authors.lastname: Reza Mohammadi
authors.forename: Homayoun
authors.initials: H
authors.lastname: Amini
mesh_terms: D000208:Acute Disease; D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000503:physiopathology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006220:Haloperidol / Q000627:therapeutic use*; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D010919:Placebos; D016713:Ritanserin / Q000627:therapeutic use*; D012701:Serotonin / Q000502:physiology; D012702:Serotonin Antagonists / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D010919:Placebos; D012702:Serotonin Antagonists; D016713:Ritanserin; D012701:Serotonin; D008094:Lithium; D006220:Haloperidol