From the Guidelines
Mania, a mental health condition characterized by abnormally elevated mood, energy, and activity levels, is typically treated with mood stabilizers like lithium, valproate, or carbamazepine, often combined with atypical antipsychotics such as olanzapine, risperidone, or quetiapine, as recommended by the most recent guidelines 1.
Diagnosis and Treatment
The diagnosis of mania involves identifying symptoms such as elevated mood, increased energy, and activity levels, which can be assessed through clinical evaluation and diagnostic criteria from the DSM-IV-TR.
Medication Treatment
The treatment of mania usually begins with mood stabilizers, which can include:
- Lithium (600-1200mg daily)
- Valproate (750-2000mg daily)
- Carbamazepine (400-1200mg daily) These medications can be combined with atypical antipsychotics, such as:
- Olanzapine (5-20mg daily)
- Risperidone (2-6mg daily)
- Quetiapine (300-800mg daily)
Maintenance Therapy
Maintenance therapy is often needed for individuals with bipolar disorder, with some requiring lifelong therapy, as recommended by the WHO guidelines 1.
Psychoeducation and Lifestyle Changes
Beyond medication, treatment should include psychoeducation, regular sleep patterns, stress management, and avoidance of substances that can trigger episodes, such as alcohol and stimulants.
Monitoring and Follow-up
Medication blood levels require regular monitoring, especially for lithium and valproate, to ensure efficacy and minimize side effects, as noted in the practice parameter for the assessment and treatment of children and adolescents with bipolar disorder 1.
From the FDA Drug Label
Lithium is indicated in the treatment of manic episodes of Bipolar Disorder. Typical symptoms of mania include pressure of speech, motor hyperactivity, reduced need for sleep, flight of ideas, grandiosity, elation, poor judgment, aggressiveness, and possibly hostility. In another trial, 361 patients meeting DSM-IV criteria for a manic or mixed episode of bipolar I disorder who had responded during an initial open-label treatment phase for about 2 weeks, on average, to olanzapine 5 to 20 mg/day were randomized to either continuation of olanzapine at their same dose (n=225) or to placebo (n=136), for observation of relapse The efficacy of oral olanzapine with concomitant lithium or valproate in the treatment of manic or mixed episodes was established in 2 controlled trials in patients who met the DSM-IV criteria for bipolar I disorder with manic or mixed episodes.
The diagnosis of mania (bipolar disorder) is based on the DSM-IV criteria, which includes symptoms such as:
- Pressure of speech
- Motor hyperactivity
- Reduced need for sleep
- Flight of ideas
- Grandiosity
- Elation
- Poor judgment
- Aggressiveness
- Hostility
The treatment for mania (bipolar disorder) includes:
- Lithium (2): indicated in the treatment of manic episodes of Bipolar Disorder, and as a maintenance treatment to reduce the frequency and intensity of manic episodes.
- Olanzapine (3): effective in the treatment of manic or mixed episodes, and can be used as an adjunct to lithium or valproate.
From the Research
Diagnosis of Mania
- The diagnosis of mania starts with a correct diagnosis and elementary measures to prevent risks for the patient, relatives, and others 4
- Patients with psychotic or mixed mania may be more difficult to treat 4
Treatment of Mania
- The treatment of mania involves the use of lithium, anticonvulsants such as valproate and carbamazepine, and antipsychotics such as chlorpromazine, haloperidol, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and asenapine 4
- Atypical antipsychotics have been shown to be effective in treating bipolar mania, either as monotherapy or in combination with traditional mood-stabilizing agents 5
- The combination of an atypical agent and a traditional mood stabilizer is generally well tolerated and represents a first-line approach for the treatment of severe and treatment-resistant mania 5
- Lithium is still considered the mood-stabilizing drug par excellence, although it may be insufficient in mixed states and severe mania 6
- Valproate and carbamazepine have been shown to be effective in treating mania, although the evidence for carbamazepine is insufficient to consider it as a first-line agent 7
- Monotherapy with second-generation antipsychotics (SGAs) demonstrates statistically significant advantages over mood stabilizers (MS) in terms of both efficacy and acceptability, and may be preferable for initial choice of treatment 8
Long-term Treatment
- The treatment of acute mania deserves a long-term view, and the evidence base for some treatments may be stronger than for others 4
- Psychoeducation of patients and caregivers is a powerful tool that should be used in combination with medication for optimal long-term outcome 4
- Functional recovery should be the ultimate goal 4
- Lithium retains the strongest evidence of efficacy in the prophylaxis of manic episodes, while lamotrigine is effective in the prevention of depressive episodes 7