Onset of action of antipsychotics in the treatment of mania

Introduction: An important consideration in treating acute mania is the pro mptness with which a chosen therapy can bring symptom amelioration. This ar ticle reviews the available published data from controlled, blinded studies regarding the latency of responses to antipsychotics in patients with acut e mania. Methods: Articles for this review wet e obtained fi om a search of the Medl ine database (1966-1999), using the following keywords and phrases: antipsy chotic. atypical, bipolar disorder, mania, neuroleptic, typical. The biblio graphic sections of articles gleaned from this search were used to direct F urther inquiries. Results: Although information regarding the onset of action of antipsychoti cs is limited, we discovered data for four typical and three atypical antip sychotics. Drugs with the fastest onsets include haloperidol, risperidone, and olanzapine, with onsets appearing in 2-6 days. Chlorpromazine and thiot hixene were at the slowest end of the continuum, with onsets of 2 weeks or longer. Data regarding pimozide are mixed, with some studies showing an ons et equivalent to that of the 'fast' compounds and others showing one simila r to that of the 'slow' compounds. Conclusions: Choice of therapy should consider nor only efficacy and safety , but also onset speed. Atypical antipsychotics appear to offer safer, fast er, and more effective therapies.