LITHIUM COMBINED WITH CARBAMAZEPINE OR HALOPERIDOL IN THE TREATMENT OF MANIA

Hospitalized manic patients were withdrawn from psychoactive medicatio ns for 2 weeks after which they were randomized to double-blind treatm ent with carbamazepine plus lithium [CBZ-Li] or haloperidol plus lithi um [HAL-Li] with benztropine. Unit dosages of Li 300 mg, CBZ 200 mg an d HAL 2 mg were titrated to therapeutic plasma levels and maintained f or 8 weeks. No rescue medications were permitted after 3 weeks. Standa rd ratings of psychopathology and side effects were accomplished weekl y. Sixty patients entered the study but only 33 remained for randomiza tion after drug washout. By 8 weeks both groups were improved from bas eline without statistically reliable differences between them. However HAL-Li patients had more extrapyramidal side effects that were major reasons for dropout, whereas CBZ-Li patients were more often noncompli ant and initially required more rescue medications. We conclude that e ither combination treatment can be beneficial but CBZ-Li has the advan tage because of fewer neurologic side effects.