COMPARISON OF THERAPEUTIC MODALITIES FOR MANIA

The results of sequential therapeutic trials in hospitalized manic pat ients conducted over a le-year period are summarized, followed by an a nalysis of pooled data to assess relative efficacy. No clinically impo rtant baseline differences were found in the patients admitted to thes e studies despite the long time span. They were not overly ''difficult to treat'' or treatment resistant, and most were discharged to the co mmunity. Nearly all outcome measures showed statistically significant differences between groups after 8 weeks of treatment. The best respon ses occurred in the patients who received a mean series of nine electr oconvulsive therapy (ECT) treatments with sparing use of neuroleptics followed by lithium maintenance. The next best outcome was observed wi th lithium combined with low doses of standard neuroleptics or risperi done. The combination of carbamazepine and lithium had significantly f ewer neurological side effects than moderate doses of haloperidol with lithium, with equivalent therapeutic results. Monotherapy with either lithium or carbamazepine was less effective than the combination trea tments. Minor differences in study design may contribute to the varian ce in outcome.