Risperidone in acute and continuation treatment of mania.
In a prospective study, we examined the efficacy of risperidone added-on to mood stabilizers in the acute and continuation treatment of mania over a 12-week period. Patients (n=108) with a DSM-IV diagnosis of bipolar disorder, manic or mixed episode requiring treatment with an antipsychotic were recruited. All subjects were on one or two mood stabilizers at the time of initiation of risperidone (range 0.5-4 mg). No other antipsychotic medication or ongoing benzodiazepine therapy was allowed. There was a significant decrease in mean Young Mania Rating Scale (YMRS) scores from baseline (27.5+/-7.5) to week 1 (-10.8, P<0.0001), week 3 (-17.7, P<0.0001) and to week 12(-22.6, P<0.0001). When response was defined as > or = 50% reduction in YMRS scores from baseline, 32%, 68% and 90% of patients met criteria at week 1, week 3 and week 12, respectively. Significant decreases in mean 21-item Hamilton Depression Rating Scale scores from baseline (12.2+/-7.7) to week 3 (-5.7, P<0.0001) and week 12 (-5.7, P<0.0001) were also observed. No significant changes in extrapyramidal symptoms were noted between baseline and endpoint. The mean daily dose of risperidone was 2 mg with a median of 1.8 mg. These findings support the results of the two previous double-blind, randomized trials and indicate that the addition of risperidone to mood stabilizers is a safe and effective treatment for acute and continuation treatment of mania. Risperidone add-on does not induce depressive symptoms and, furthermore, risperidone may have efficacy in treating comorbid depressive symptoms in bipolar patients.
Yatham
Lakshmi N
LN
Department of Psychiatry, University of British Columbia, Vancouver, Canada. yatham@interchange.ubc.ca
Binder
Carin
C
Riccardelli
Rosanna
R
Leblanc
Jean
J
Connolly
Mary
M
Kusumakar
Vivek
V
D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D002220:Carbamazepine / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D018967:Risperidone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D014635:Valproic Acid / Q000627:therapeutic use
D018692:Antimanic Agents; D014150:Antipsychotic Agents; D018020:Lithium Compounds; D002220:Carbamazepine; D014635:Valproic Acid; D018967:Risperidone