title: Efficacy of olanzapine combined with valproate or lithium in the treatment of dysphoric mania.
abstract: BACKGROUND
  Few controlled studies examine the treatment of depressive features in mania.
  
  
  OBJECTIVE
  To evaluate the efficacy of olanzapine, in combination with lithium or valproate, for treating depressive symptoms associated with mania.
  
  
  METHODS
  Secondary analysis of a 6-week, double-blind, randomised study of olanzapine (5-20 mg/day) or placebo combined with ongoing valproate or lithium open treatment for 344 patients in mixed or manic episodes. This analysis focused on a dysphoric subgroup with baseline Hamilton Rating Scale for Depression (HRSD) total scores of 20 or over contrasted with non-dysphoric patients.
  
  
  RESULTS
  In the dysphoric subgroup (n=85) mean HRSD total score improvement was significantly greater in olanzapine co-therapy patients than in those receiving placebo plus lithium or valproate (P<0.001). Substantial contributors to this superiority included the HRSD Maier sub-scale (P=0.013) and the suicide item (P=0.001). Total Young Mania Rating Scale improvement was also superior with olanzapine co-therapy.
  
  
  CONCLUSIONS
  In patients with acute dysphoric mania, addition of olanzapine to ongoing lithium or valproate monotherapy significantly improved depressive symptom, mania and suicidality ratings.
authors.affiliation: Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN 46285, USA. robertbaker@lilly.com
authors.forename: Robert W
authors.initials: RW
authors.lastname: Baker
authors.forename: Eileen
authors.initials: E
authors.lastname: Brown
authors.forename: Hagop S
authors.initials: HS
authors.lastname: Akiskal
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
authors.forename: Terence A
authors.initials: TA
authors.lastname: Ketter
authors.forename: Leslie M
authors.initials: LM
authors.lastname: Schuh
authors.forename: Paula T
authors.initials: PT
authors.lastname: Trzepacz
authors.forename: John G
authors.initials: JG
authors.lastname: Watkin
authors.forename: Mauricio
authors.initials: M
authors.lastname: Tohen
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents; D001569:Benzodiazepines / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D003866:Depressive Disorder / Q000188:drug therapy; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use*; D008297:Male; D000077152:Olanzapine; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use*
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D016651:Lithium Carbonate; D014635:Valproic Acid; D000077152:Olanzapine