Acute mania: Haloperidol dose and augmentation with lithium or lorazepam

Antipsychotic dosing for acute mania has not been well. studied. Combined t reatment with lithium and an antipsychotic is the most common treatment, bu t additional antimanic efficacy of a Lithium-antipsychotic combination beyo nd that of an antipsychotic alone has not been well demonstrated. Furthermo re, the possibility that lithium could affect antipsychotic dose requiremen t is believed to have never been studied. In this study, 63 acutely psychot ic bipolar manic inpatients were randomly assigned to receive double-blind treatment with 1 of 2 haloperidol doses, 25 mg/day or 5 mg/day, for 21 days . In addition to haloperidol, subjects were randomly assigned to receive co ncomitant treatment with placebo, standard lithium, or lorazepam 4 mg/day. The high haloperidol dose produced greater improvement and more side effect s than did the low dose. Lithium added to the low dose produced a markedly greater clinical response than did the low dose alone. Lorazepam did not im prove the outcome for the patients receiving low-dose haloperidol. The clin ical response produced by high-dose haloperidol was not enhanced by adding either Lithium or lorazepam. All treatment effects emerged by the fourth da y of treatment and persisted. Used alone, a haloperidol dose of 5 mg/day is too low for most manic patients, but concomitant lithium produces a dose-d ependent enhancement of haloperidol response. Lorazepam 4 mg/day was insuff icient to produce an advantage when added to low-dose haloperidol.