title: Topiramate and divalproex in combination with risperidone for acute mania: a randomized open-label study.
abstract: Mood stabilizers and atypical antipsychotics are commonly combined for the treatment of bipolar mania. The aim of this study was to compare the effectiveness and tolerability of topiramate and divalproex in combination with risperidone for treating acute mania patients in a naturalistic treatment setting. Seventy-four patients who met the DSM-IV criteria for bipolar mania were enrolled in this study. In order to assess the efficacy and the extrapyramidal symptoms (EPS), the Young Mania Rating Scale (YMRS), Clinical Global Impression (CGI) and Simpson-Angus Rating Scale (SARS) were measured at the baseline and at weeks 1, 3 and 6. From the baseline to the endpoint, the YMRS and CGI scores were reduced by 67.9% and 56.6% in the topiramate plus risperidone group (TPMG). The YMRS and CGI scores were also reduced by 63.7% and 58.2% in the divalproex plus risperidone group (DVPG). The weight and body mass index (BMI) increased significantly by 3.6% and 3.3% from the baseline to the endpoint in the DVPG, while they decreased by 0.5% and 0.4%, respectively, with no significant difference in the TPMG. There were no serious adverse events in either group. Despite the methodological limitations, topiramate was effective and tolerable for treating acute mania and may also be a promising alternative to a weight-gain liable mood stabilizer (MS) such as divalproex.
authors.affiliation: Department of Psychiatry, St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea.
authors.forename: Won-Myong
authors.initials: WM
authors.lastname: Bahk
authors.forename: Young-Chul
authors.initials: YC
authors.lastname: Shin
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Woo
authors.forename: Bo-Hyun
authors.initials: BH
authors.lastname: Yoon
authors.forename: Jung-Seo
authors.initials: JS
authors.lastname: Lee
authors.forename: Duk-In
authors.initials: DI
authors.lastname: Jon
authors.forename: Sang-Keun
authors.initials: SK
authors.lastname: Chung
authors.forename: Sung-Ku
authors.initials: SK
authors.lastname: Choi
authors.forename: In-Ho
authors.initials: IH
authors.lastname: Paik
authors.forename: Chi-Un
authors.initials: CU
authors.lastname: Pae
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D018692:Antimanic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001480:Basal Ganglia Diseases / Q000139:chemically induced / Q000453:epidemiology; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D015992:Body Mass Index; D004359:Drug Therapy, Combination; D005260:Female; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use*; D000077236:Topiramate; D014635:Valproic Acid / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents; D018696:Neuroprotective Agents; D000077236:Topiramate; D005632:Fructose; D014635:Valproic Acid; D018967:Risperidone