[Comparison of the efficacy of two combinations; sodium valproate with lithium and sodium valproate with olanzapine treatment of acute mania]

ABSTRACT

Acute mania is a psychiatric emergency state that often requires rapid management. There are many different therapeutic protocols for this emergent situation. One of them is combination of moodstabilizers and antipsychotics. Olanzapine which is now available in our country can be used for this purpose. In this study, we compared the effectiveness, rapidity of response and side effects of sodium valproate plus olanzapine [group I] with sodium valproate plus lithium [group II] in acutely manic or mixed bipolar patients. In this randomized, double blind, parallel group study, 44 acutely manic or mixed patients according to DSM IV-TR criteria were randomly assigned to receive combinations of sodium valproate [20mg/kg per day] with either olanzapine [5-15mg/day] or lithium [900mg/day] during a ten-day course. Efficacy was measured with Young Mania Rating Scale [YMRS]. Effectiveness measures included YMRS response [YMRS reduction >/= 50%] and YMRS remission [YMRS<=12]. Data was entered in SPSS11 software program and analyzed by Mann-Whitney, Fisher exact test and Wilcoxon tests [P-values < 0.05 were significant]. Total number of patients were 44 [mean age 27.18 +/- 7.34], 21 in group I and 23 in group II. Response rate was 85.7% [18 patients] and 73.9% [17 patients] in group I and II, respectively; with no significant differences between the two groups[P=0.33]. Remission rate was 42.9%[9 patients] and 43.5% [10 patients] in group I and II, respectively; with no significant differences between two groups[P=0.97]. The reduction in total scores in YMRS on the 2nd, 7th and 10th days of study were significant in both groups [P<0.05], but the rapidity of response was similar. The rates of adverse effects between two groups were not statistically significant. Both combinations of drugs were effective in acutely manic or mixed patients. Both treatments were safe and well tolerated