title: A Naturalistic, Single-blind Comparison of Rapid Dose Administration of Divalproex ER Versus Quetiapine in Patients with Acute Bipolar Mania.
abstract: OBJECTIVE
  When treating acute bipolar mania, the speed of onset of anti-manic effects is crucial. Quetiapine and divalproex ER are widely used agents to treat acute mania. Rapid dose administration regimens for divalproex ER and for quetiapine have been described. We conducted a naturalistic, head-to-head, pilot study comparing the efficacy and safety of rapidly titrated divalproex ER and quetiapine in acutely manic inpatients, with the primary outcome being improvement within the first seven days.
  
  
  METHODS
  Thirty consenting bipolar patients with acute mania (Young Mania Rating Scale >17 ) needing hospitalization due to acute mania were randomized to receive rapidly loaded divalproex ER (30mg/kg/day) or rapidly titrated quetiapine (200mg Day 1, raised by 200mg/day up to 800mg as tolerated). Assessments were made on Day 1 (baseline), Day 3, Day 7, Day 14, and Day 21 and included Young Mania Rating Scale, Clinical Global Impressions-Severity, Clinical Global Impressions-Improvement, and Montgomery-Asberg Depression Rating Scale. Raters but not patients or treating physicians were blinded (single-blinded study).
  
  
  RESULTS
  Subjects in both treatment groups exhibited significant and rapid improvement in their mania starting at Day 3 with few significant adverse effects; however, there were no significant differences in the degree or rate of improvement between the two treatment groups in any of the efficacy or adverse effects scales.
  
  
  CONCLUSIONS
  RESULTS of this small study indicate that rapid-dose administration of both quetiapine and divalproex ER produce rapid improvement in acute mania within the first seven days and both seem to be well tolerated.
authors.affiliation: All from the Department of Psychiatry, University of California San Diego Medical Center, San Diego, California.
authors.forename: David
authors.initials: D
authors.lastname: Feifel
authors.forename: Barbara
authors.initials: B
authors.lastname: Galangue
authors.forename: Kai
authors.initials: K
authors.lastname: Macdonald
authors.forename: Patrice
authors.initials: P
authors.lastname: Cobb
authors.forename: Ana
authors.initials: A
authors.lastname: Dinca
authors.forename: Olga
authors.initials: O
authors.lastname: Becker
authors.forename: J
authors.initials: J
authors.lastname: Cooper
authors.forename: Allison
authors.initials: A
authors.lastname: Hadley